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Although the risk of thromboembolism in patients off anticoagulation is higher than the overall risk of ICH recur-rence, there is a marked paucity of prospective large population-based d

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Carlos A Molina and Magdy H Selim

Evidence Facing Big Fears The Dilemma of Resuming Anticoagulation After Intracranial Hemorrhage : Little

Print ISSN: 0039-2499 Online ISSN: 1524-4628 Copyright © 2011 American Heart Association, Inc All rights reserved

is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231

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doi: 10.1161/STROKEAHA.111.631689 2011;42:3665-3666; originally published online November 3, 2011;

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The Dilemma of Resuming Anticoagulation After

Intracranial Hemorrhage

Little Evidence Facing Big Fears

Carlos A Molina, MD, PhD; Magdy H Selim, MD, PhD

Intracranial hemorrhage (ICH) is the most feared and

devastating complication of anticoagulant treatment,

lead-ing to death or disability in two thirds of cases Once ICH

occurs, the decision of whether to resume anticoagulation is a

true therapeutic dilemma that requires balancing the

compet-ing risks of hematoma growth or recurrent ICH and disablcompet-ing

thromboembolic events

Although the risk of thromboembolism in patients off

anticoagulation is higher than the overall risk of ICH

recur-rence, there is a marked paucity of prospective large

population-based data on the real risk of ICH recurrence on

warfarin The lack of randomized controlled trials probably

reflects the ethical challenge of prescribing patients a

medi-cation to which they have an apparent contraindimedi-cation

Therefore, in clinical practice, the risk is usually, and

inap-propriately, extrapolated from the overall risk of major

bleeding on warfarin (approximately 3%), in which older age

and elevated international normalized ratio are factors

asso-ciated with an increased risk

The little evidence available on resuming oral

anticoagu-lation after ICH comes from either expert opinions or few

nonrandomized mainly retrospective studies.1,2These studies

included highly selected high-risk patients and showed

non-conclusive and even discrepant results This limited and weak

evidence along with our own experience and common sense

are the weapons that our protagonists use for facing the

physicians’ fears and uncertainties of increasing the risk of a

devastating recurrent ICH or leaving the patient unprotected

from thromboembolic complications Dr Shulman’s argument

is based on the high risk of recurrent ICH on warfarin after

ICH at any location and gives a broad recommendation of

abstaining from resuming warfarin He argues that in our

case, warfarin should not be resumed because the risk of

recurrent ICH (15%) is more than twice as high as the risk of

ischemic stroke (6%) Dr Steiner delineates a more restrictive

scenario, in which the risk of thromboembolism outweighs

the risk of ICH recurrence in a hypertensive-related, nonlobar

ICH He recommends that warfarin should be restarted if

blood pressure and other risk factors are adequately controlled

Among all factors associated with an increased risk of recurrent ICH on warfarin, ICH location and documented history of thromboembolism seem to be the key factors that tilt the risk/benefit balance of restarting anticoagulation after ICH In 1 of the only 2 published epidemiological studies, the risk of recurrent ICH on warfarin was⬎5-fold higher in lobar compared with deep ICH, although the rate of survival among patients with deep ICH was low The topographical location

of ICH may reflect the underlying microvascular pathology Lobar ICH in the aged population is associated with cerebral amyloid angiopathy and an inherent high risk of recurrence Deep ICH is often hypertension-related Although improved management of hypertension can reduce the risk of recurrent deep ICH, there is limited room for improving management

in lobar ICH if blood pressure is well controlled On the other hand, in an analysis of 52 patients, thromboembolic events occurred in 48% of patients in whom warfarin was not restarted, all of them were being treated for a previous event, suggesting that secondary rather than primary prevention is a stronger indication for resuming anticoagulation.2

The dilemma of restarting oral anticoagulation in the long-term management of ICH may be better addressed by considering other factors, including the underlying reason for which the patient was originally started on anticoagulation, difficulties in controlling the international normalized ratio, the risk of thromboembolic stroke based on the CHADS2 score, and the presence and extent of microbleeds on gradient-echo MRI Deep ICH, secondary prevention, high CHADS2 score, mechanical valve, or hypercoagulable state are factors arguing in favor of resumption of anticoagulation Conversely, lobar ICH, presence of multiple microbleeds on MRI, low CHADS2 score, and difficulties controlling inter-national normalized ratio configure an unfavorable risk/ benefit profile In addition to these factors, the decision of whether to resume anticoagulation must take into consider-ation the underlying cause of ICH For example, treatable

The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association This article is Part 3 of a 3-part article Parts 1 and 2 appear on pages 3661 and 3663, respectively.

Received August 1, 2011; accepted August 8, 2011.

From Hospital Valld’Hebron-Barcelona (C.A.M.), Barcelona, Spain; and the Stroke Division (M.H.S.), Beth Israel Deaconess Medical Center, Boston, MA Correspondence to Carlos A Molina, MD, PhD, Stroke Unit, Department of Neurosciences, Hospital Valld’Hebron-Barcelona, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain E-mail cmolina@vhebron.net; and Magdy H Selim, MD, PhD, Beth Israel Deaconess Medical Center, Stroke Division, 330 Brookline Avenue, Palmer 127, Boston, MA 02215 E-mail mselim@bidmc.harvard.edu

(Stroke 2011;42:3665-3666.)

© 2011 American Heart Association, Inc.

Stroke is available at http://stroke.ahajournals.org DOI: 10.1161/STROKEAHA.111.631689

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secondary causes of ICH such as an arteriovenous

malforma-tion, in which concomitant use of anticoagulation is only

guilty by association, may not pose a risk for ICH recurrence

once treated; and traumatic ICH in the setting of

anticoagu-lant use does not necessarily imply increased risk for ICH

recurrence

The optimal timing for resumption of anticoagulation after

ICH is unresolved In the acute phase, the risk of continuous

bleeding from restarting anticoagulation exceeds the risk of

thromboembolism from withholding it Later on, the risk of

stroke and systemic embolism in the absence of

anticoagula-tion outweighs that of rebleeding Therefore, both the

Amer-ican Heart Association and the European Stroke Initiative

recommend that in patients with high risk of

thromboembo-lism, anticoagulation should be restarted between 7 and 10

days Dr Shulman and his colleagues, however, questioned

these recommendations and suggested that the optimal time

for resumption of anticoagulation is after 10 weeks Clearly,

the timing depends on the indication for anticoagulation and

the patient’s comorbidities

In patients with atrial fibrillation and an unfavorable

risk/benefit profile to restarting anticoagulation, antiplatelet

therapy is a reasonable alternative In some, the use of a left

atrial appendage occlusion device or procedure may be

another consideration Although dabigatran has demonstrated

fewer bleeding complications in patients with atrial fibrilla-tion, compared with warfarin, safety and efficacy data in patients with ICH is lacking

The current dilemma is likely to persist despite ongoing efforts to develop decision-support tools given the heteroge-neity of the underlying causes of anticoagulation-related ICH and patient populations It exemplifies the fact that medicine

is an art and that the decision of whether and when to resume anticoagulation after ICH should be made on an individual case-by-case basis after taking into considerations the pa-tient’s risk factors for thromboembolism and his or her preferences after a thorough discussion of the risks versus benefits

Disclosures

None.

References

1 De Vleeschouwer S, Van Calenbergh F, van Loon J, Nuttin B, Goffin J, Plets C Risk analysis of thromboembolic and recurrent bleeding events in the management of intracranial hemorrhage due to oral anticoagulation.

Arch Chir Belg 2005;105:268 –274.

2 Classen DO, Kazemi N, Zubkov AY, Wijdicks EF, Rabinstein AA Restarting anticoagulation therapy after warfarin-associated intracranial

hemorrhage Arch Neurol 2008;65:1313–1318.

K EY W ORDS : acute stroke 䡲 hemorrah 䡲 intracranial stenosis

3666 Stroke December 2011

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