Anticoagulant-induced intracerebral haemorrhage (ICH): resuming anticoagulation

Evidence-based neurology checklist on anticoagulant-induced intracerebral haemorrhage (ich): resuming anticoagulation: Resuming anticoagulation without mechanical heart valve This has a low thrombotic risk Delay anticoagulation for at least 4 weeks The greatest benefit-risk balance is a delay of…

Resuming anticoagulation without mechanical heart valve

  • This has a low thrombotic risk
  • Delay anticoagulation for at least 4 weeks
  • The greatest benefit-risk balance is a delay of 7-8 weeks

Resuming anticoagulation with mechanical heart valve

Indications for early resumption of anticoagulation

Risk factors for re-bleeding on resuming anticoagulation

Indications for antiplatelets instead of resuming anticoagulation

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References

  1. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-2236.
  2. Hemphill JC 3rd, Greenberg SM, Anderson CS, et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46:2032-2060.
  3. Tomaselli GF, Mahaffey KW, Cuker A, et al. 2017 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017; 70:3042-3067. 
  4. Pennlert J, Overholser R, Asplund K, et al. Optimal timing of anticoagulant treatment after intracerebral hemorrhage in patients with atrial fibrillation. Stroke 2017; 48:314-320. 
  5. AlKherayf F, Xu Y, Westwick H, Moldovan ID, Wells PS. Timing of anticoagulant re-initiation following intracerebral hemorrhage in mechanical heart valves: survey of neurosurgeons and thrombosis experts. Clin Neurol Neurosurg 2017; 154:23-27.
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