Antithrombotic Therapy After Intracerebral Hemorrhage: Real-World Evidence for In-Hospital Resumption

Area of Science:

• Neurology
• Cardiology
• Hematology

Background:

• Patients with intracerebral hemorrhage (ICH) requiring antithrombotic therapy (AT) face risks of bleeding and ischemic events.
• Optimal timing for resuming AT during hospitalization after ICH is unclear.

Purpose of the Study:

• To evaluate if restarting AT in hospitalized patients with acute spontaneous ICH reduces ischemic complications.
• To assess if AT resumption increases hemorrhagic risk.

Main Methods:

• Retrospective cohort study of 601 adults admitted with spontaneous ICH (2014-2022).
• Patients categorized into: no AT, AT indicated but not treated, AT indicated and treated.
• Primary endpoints: ischemic events (stroke, TIA, MI, PE, DVT) and hemorrhagic events (ICH, hematoma expansion).

Main Results:

• Restarting AT (n=98) significantly reduced ischemic events (14.3% vs. 28.7%; aHR 0.34) compared to no AT.
• No significant increase in hemorrhagic events was observed with AT resumption (5.1% vs. 6.3%; aHR 0.67).
• Findings were confirmed by competing-risk models and sensitivity analysis.

Conclusions:

• In-hospital resumption of AT after acute spontaneous ICH decreases ischemic events.
• AT resumption does not appear to increase hemorrhagic risk in carefully selected patients.
• Supports the potential benefit of carefully timed AT resumption after ICH.