Anticoagulation in people with atrial fibrillation after intracranial haemorrhage

For people with atrial fibrillation, anticoagulation can reduce the risk of stroke by approximately two-thirds. However, their risk of bleeding is high, causing a dilemma for clinicians on whether to prescribe anticoagulants or not when managing these patients after intracranial haemorrhage. Therefore, it is crucial to evaluate risks versus benefits of anticoagulants in these high-risk patients. Fortunately, since the warfarin era, the balance between benefit and risk of bleeding has now improved with the use of direct oral anticoagulants. The risk of a first event of intracranial haemorrhage is reduced by about half in people with atrial fibrillation treated with direct oral anticoagulants, compared with warfarin. 1 Ruff CT Giugliano RP Braunwald E et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014; 383: 955-962 Summary Full Text Full Text PDF PubMed Scopus (3600) Google Scholar However, the safety and efficacy of anticoagulation with direct oral anticoagulants in patients with atrial fibrillation after intracranial haemorrhage is unclear, because these patients are typically excluded from randomised controlled trials. Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trialsFor people with atrial fibrillation and intracranial haemorrhage, oral anticoagulation had uncertain effects on the risk of any stroke or cardiovascular death (both overall and in subgroups), haemorrhagic major adverse cardiovascular events, and functional outcome. Oral anticoagulation reduced the risk of ischaemic major adverse cardiovascular events, which can inform clinical practice. These findings should encourage recruitment to, and completion of, ongoing trials. Full-Text PDF Open Access