Resumption of oral anticoagulation in patients with non-valvular atrial fibrillation after intracerebral hemorrhage: A sub-analysis of the PASTA registry study

Suda, Satoshi; Iguchi, Yasuyuki; Yagita, Yoshiki; Kanzawa, Takao; Okubo, Seiji; Fujimoto, Shigeru; Kono, Yu; Kimura, Kazumi

doi:10.1016/j.jns.2023.120810

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…While the resumption of anticoagulants should be performed with great caution in those patients with lobar ICH due to the extremely high risk of rebleeding [ 21 , 41 ]. Once the risk of rebleeding is low enough to no longer exceed the risk of potential recurrent ischemic events, anticoagulation might be further resumed, but it should be noted that the optimal timing of anticoagulation resumption also has an important impact on the outcome of patients with AAICH [ 132 ].…”

Section: Resumption Of Anticoagulants In Aaichmentioning

confidence: 99%

Reversal and resumption of anticoagulants in patients with anticoagulant-associated intracerebral hemorrhage

Yang,

Jing,

Chen

et al. 2024

Eur J Med Res

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The use of anticoagulants has become more frequent due to the progressive aging population and increased thromboembolic events. Consequently, the proportion of anticoagulant-associated intracerebral hemorrhage (AAICH) in stroke patients is gradually increasing. Compared with intracerebral hemorrhage (ICH) patients without coagulopathy, patients with AAICH may have larger hematomas, worse prognoses, and higher mortality. Given the need for anticoagulant reversal and resumption, the management of AAICH differs from that of conventional medical or surgical treatments for ICH, and it is more specific. Understanding the pharmacology of anticoagulants and identifying agents that can reverse their effects in the early stages are crucial for treating life-threatening AAICH. When patients transition beyond the acute phase and their vital signs stabilize, it is important to consider resuming anticoagulants at the right time to prevent the occurrence of further thromboembolism. However, the timing and strategy for reversing and resuming anticoagulants are still in a dilemma. Herein, we summarize the important clinical studies, reviews, and related guidelines published in the past few years that focus on the reversal and resumption of anticoagulants in AAICH patients to help implement decisive diagnosis and treatment strategies in the clinical setting.

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Section: Resumption Of Anticoagulants In Aaichmentioning

confidence: 99%

Reversal and resumption of anticoagulants in patients with anticoagulant-associated intracerebral hemorrhage

Yang,

Jing,

Chen

et al. 2024

Eur J Med Res

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“…The European Heart Rhythm Association Practical Guide recommends restarting anticoagulation in selected patients with AF and ICH at least 4 weeks after the ICH event [ 31 ]; however, the quality of evidence supporting this recommendation is poor and it is uncertain whether it has translated into clinical practice. Prospective observational data from a Japanese study in which anticoagulants were resumed in 68% of patients and the median time to resumption was 7 days after ICH suggest that early resumption in patients with NVAF after ICH onset is safe [ 39 ]. When anticoagulation was restarted, warfarin was switched to a DOAC, and DOACs were switched to another DOAC type.…”

Section: Anticoagulationmentioning

confidence: 99%

Cardioembolic Stroke: Past Advancements, Current Challenges, and Future Directions

Kato,

Tsutsui,

Nakano

et al. 2024

IJMS

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Cardioembolic stroke accounts for over 20% of ischemic strokes and is associated with worse outcomes than other types of strokes. Atrial fibrillation (AF) is the most common risk factor for cardioembolic stroke. In this narrative review, we present an update about cardioembolic stroke mainly related to AF and atrial cardiopathy. Direct oral anticoagulants (DOACs) have revolutionized stroke prevention in patients with AF; however, their efficacy in preventing recurrent embolic stroke of unknown source remains uncertain. Various cardiac monitoring methods are used to detect AF, which is crucial for preventing stroke recurrence. DOACs are preferred over warfarin for AF-related stroke prevention; however, the timing of initiation after acute ischemic stroke is debated. Resuming anticoagulation after intracerebral hemorrhage in AF patients requires careful assessment of the risks. While catheter ablation may reduce the incidence of cardiovascular events, its effect on stroke prevention is unclear, especially in heart failure patients. Atrial cardiopathy is the emerging cause of embolic stroke of unknown source, which indicates atrial structural and functional disorders that can precede AF. Future research should focus on refining stroke risk prediction models, optimizing AF detection, understanding the roles of ablation and anticoagulation in stroke prevention, and establishing atrial cardiopathy as a therapeutic target, which could significantly reduce the burden of stroke.

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Resumption of oral anticoagulation in patients with non-valvular atrial fibrillation after intracerebral hemorrhage: A sub-analysis of the PASTA registry study

Cited by 2 publications

References 33 publications

Reversal and resumption of anticoagulants in patients with anticoagulant-associated intracerebral hemorrhage

Reversal and resumption of anticoagulants in patients with anticoagulant-associated intracerebral hemorrhage

Cardioembolic Stroke: Past Advancements, Current Challenges, and Future Directions

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