Table 2 Studies reporting the resumption of anticoagulants after ICH
Study (pub. year) | Design | Sample size | Resumption of anticoagulants | Time of anticoagulants restarting | Risk of hemorrhagic complications (per 100 person-years) | Risk of thromboembolism (per 100 person-years) | Outcomes of ICH patients with anticoagulants resumption | ||
|---|---|---|---|---|---|---|---|---|---|
Patients with anticoagulants resumption | Patients without anticoagulants resumption | Patients with anticoagulants resumption | Patients without anticoagulants resumption | ||||||
Suda (2023) [132] | Retrospective | 160 | DOACs | 7 days (4–11 days) | NA | NA | NA | NA | Early resumption of DOACs after ICH appeared to be safe in patients with NVAF. Expected functional outcomes were associated with the timing of resumption |
Lin (2022) [113] | Retrospective | 1899 | VKAs/DOACs | 42 days (10–127 days) | 1.4 | 1.6 | 3.5 | 4.9 | Reduced risk of ischemic stroke, without increased risk of recurrent ICH compared with no treatment. DOACs users had lower mortality compared with warfarin |
SoSTART (2021) [125] | Prospective | 203 | VKAs/DOACs | 115 days (49–265 days) | 8 | 4 | 11 | 22 | Starting oral anticoagulation was non-inferior to avoiding it |
APACHE-AF (2021) [126] | Prospective | 101 | DOACs (Apixaban) | 46 days (21–74 days) | 12 | 6 | 12.6 | 11.9 | Starting or avoiding oral anticoagulation both had high annual risks of non-fatal stroke or vascular death |
Lee (2020) [111] | Retrospective | 5712 | VKAs/DOACs | 0.6 year (0.2–1.7 year) | NA | NA | NA | NA | DOACs use was associated with lower risks of ischemic stroke, ICH, and composite outcome than warfarin |
Tsai (2020) [112] | Retrospective | 4540 | VKAs/DOACs | NA | NA | NA | NA | NA | DOACs use was associated with lower rates of ICH and major bleeding compared with warfarin use |
Poli (2018) [114] | Retrospective | 244 | VKAs/DOACs | 1–3 months | 1.0 | 1.0 | 2.0 | 6.0 | A lower rate of ischemic stroke/SE and all-cause mortality with no significant increase in major bleeding |
Murthy (2017) [117] | Meta-analysis | 5306 (8 studies) | VKAs/DOACs | A median of 10–39 days | 8.7 | 7.8 | 6.7 | 17.6 | A lower risk of thromboembolic complications and a similar risk of ICH recurrence |
Chai-Adisaksopha (2017) [118] | Meta-analysis | 3145 (10 studies) | VKAs (Warfarin) | 31 days | 6.7 | 7.7 | 3.5 | 7.0 | Reduction of all-cause mortality and ischemic stroke and no significantly increased recurrent intracranial bleeding |
Korompoki (2017) [14] | Meta-analysis | 2452 (7 studies) | VKAs (Warfarin) | NA | 4.6 | 4.0 | 3.2 | 7.3 | A lower rate of ischemic stroke without causing a major increase in the risk of ICH recurrence |
Nielsen (2017) [115] | Retrospective | 2415 | VKAs (Warfarin) | 31 days | 5.8 | 5.3 | 3.3 | 8.9 | A lower rate of ischemic stroke or SE and an increased rate of recurrent ICH, but these differences did not reach statistical significance |
Pennlert (2017) [116] | Retrospective | 2619 | NA | Within 8 weeks | 6.9 per 3y | 4.4 per 3y | 6.3 per 3y | 13.8 per 3y | A reduced rate of thrombotic events with no significantly increased rate of hemorrhagic events |
Chao (2016) [122] | Retrospective | 12 917 | VKAs (Warfarin) | NA | 5.9 | 4.2 | 3.4 | 5.8 | The use of warfarin may be beneficial to patients who have atrial fibrillation with a previous ICH and a CHA2DS2–VASc score ≥ 6 |
Park (2016) [119] | Retrospective | 428 | VKAs (Warfarin) | 117.5 ± 235.7 days | 5.5 | 3.1 | 2.4 | 8.3 | The initiation of anticoagulants at least 2 weeks after ICH was associated with improved clinical outcomes |
Ottosen (2016) [110] | Retrospective | 6369 | VKAs/DOACs | Within first 6 months | NA | NA | NA | NA | Lower risks of all-cause mortality and thromboembolic events and no increased risk of major bleeding |
Nielsen (2015) [109] | Retrospective | 1752 | VKAs/DOACs | 34 days | 8.0 | 8.6 | 5.3 | 10.4 | A significant reduction in ischemic stroke/all-cause mortality rates |
Kuramatsu (2015) [10] | Retrospective | 719 | VKAs or active heparinization before resumption | 31Â days | 8.1 | 6.6 | 5.2 | 15.0 | Lower risk of ischemic events |
Witt (2015) [120] | Retrospective | 160 | VKAs (Warfarin) | 14 days | 7.6 | 3.7 | 3.7 | 12.3 | No increased risk of recurrent ICH but trending toward reduced thrombosis and all-cause mortality |