Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial

Risk of Cerebrovascular Events in Intracerebral Hemorrhage Survivors With Atrial Fibrillation: A Nationwide Cohort Study

“…Several randomized controlled trials are currently investigating the optimal antithrombotic treatment strategy for stroke prevention in ICH survivors with concomitant AF, 9–14 and 2 of these trials have now been concluded and reported. 22,23 Both trials were inconclusive and likely underpowered to detect a signal of benefit or harm from OAC treatment, and the trial investigators call for additional trial data to provide more robust evidence. Awaiting these results of ongoing trials become available, observational data such as the present on the risk of both ischemic and hemorrhagic cerebrovascular events in patient with AF surviving an ICH are important to provide additional scientific basis for the multidisciplinary expert consensus-decision approach on antithrombotic treatment that is presently recommended by guidelines.…”

“…Several randomized controlled trials are currently investigating the optimal antithrombotic treatment strategy for stroke prevention in ICH survivors with concomitant AF, 9–14 and 2 of these trials have now been concluded and reported. 22,23 Both trials were inconclusive and likely underpowered to detect a signal of benefit or harm from OAC treatment, and the trial investigators call for additional trial data to provide more robust evidence.…”

“…Several randomized controlled trials are currently investigating antithrombotic treatment options for stroke prevention in ICH survivors with concomitant AF. 9–14 An ongoing European multinational randomized controlled trial, the PRESTIGE-AF (Prevention of Stroke in Intracerebral Haemorrhage Survivors With Atrial Fibrillation) trial is investigating stroke prevention strategies in patients with AF surviving an ICH. 13 Patients are randomized to either a nonvitamin K antagonist oral anticoagulant (NOAC) or no anticoagulation.…”

Protecting the Brain, From the Heart: Safely Mitigating the Consequences of Thrombosis in Intracerebral Hemorrhage Survivors With Atrial Fibrillation

“…The first 2 RCTs investigating the safety and efficacy of OAC in patients with recent ICH and previous AF were recently published: The SoSTART (Start or Stop Anticoagulants Randomized Trial) and APACHE-AF (Apixaban After Anticoagulation-Associated Intracerebral Hemorrhage in Patients With Atrial Fibrillation) trials (Table 2). 26,27 The SoSTART trial randomized 203 British participants (median age 79 years) with intracranial hemorrhage either to start or to avoid OAC and were followed up for a median of 1.2 years. With 8% and 4% of recurrent intracranial hemorrhages in the arm to start and avoid, respectively, the study failed to demonstrate noninferiority of OAC resumption (adjusted hazard ratio, 2.42 [95% CI, 0.72-8.09]).…”

Antithrombotic dilemmas in stroke medicine: new data, unsolved challenges

“…The Start or Stop Anticoagulants Randomised Trial (SoSTART) randomised 203 participants with previous spontaneous intracranial haemorrhage (92% intracerebral, 84% OAC-associated) to start or avoid OAC 22. The median time from onset to randomisation was 115 days (IQR 49–265), and nearly all participants starting anticoagulation received an NOAC.…”