Anticoagulation in the context of post-intracerebral haemorrhage: A narrative review

Recommencement of oral anticoagulation (OAC) for patients post-intracerebral haemorrhage (ICH) remains a challenging decision for clinicians. High-quality evidence to assist with this decision is lacking and current guidelines primarily focus on balancing thromboembolic and bleeding risk.

This study evaluated the literature and current guidelines for recommencement of OAC in patients who have experienced an incident ICH.

Patients with recurrent ICH while on anticoagulation therapy have associated poor outcomes. However, predicting which patients will experience recurrent ICH with OAC resumption remains challenging, and failure to resume OAC carries risks of thromboembolic events. Current data suggest that it is reasonable to resume OAC in many patients post-ICH, depending on careful consideration of individual risk factors for haemorrhagic and thromboembolic events. The application of existing risk stratification tools for thromboembolism and haemorrhage, and radiological biomarkers such as cerebral microbleeds, might also assist in decision making.