| Autor: |
Grainger, Brian T., McFadyen, James D., Tran, Huyen |
| Zdroj: |
Journal of Thrombosis and Haemostasis; 20230101, Issue: Preprints |
| Abstrakt: |
Intracranial haemorrhage (ICH) is the most feared and lethal complication of oral anticoagulant (OAC) therapy. Resumption of OAC following ICH has long posed a challenge for clinicians, complicated by the expanding range of anticoagulant agents available in modern clinical practice, including the direct oral anticoagulants (DOACs) and more recently, the factor XI and XII inhibitors. A review of the current literature finds support for resuming OAC in the majority of patients post-ICH based on pooled retrospective data showing that resumption is associated a lower risk of mortality and thromboembolism without a significantly increased risk of recurrent haemorrhage. The optimal time to resume OAC is less clear, however the available evidence suggests the composite risk of both recurrent haemorrhage and thromboembolism is likely minimised somewhere between 4-6 weeks after ICH in most patients. Specific considerations to guide the optimal resumption time in the individual patient include ICH location, mechanism and anticoagulant class. Patients with mechanical heart valves and intracerebral malignancy represent high risk groups who require more nuanced decision-making. Here we appraise the literature with the aim of providing a practical guide for clinicians while also discussing priorities for future investigation. |
| Databáze: |
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