Summary
Intracranial haemorrhage (ICH), which affects up to 1% of patients on oral anticoagulation
per year, is the most feared and devastating complication of this treatment. After
such an event, it is unclear whether anticoagulant therapy should be resumed. Such
a decision hinges upon the assessment of the competing risks of haematoma growth or
recurrent ICH and thromboembolic events. ICH location and the risk for ischaemic cerebrovascular
event seem to be the key factors that lead to risk/benefit balance of restarting anticoagulation
after ICH. Patients with lobar haemorrhage or cerebral amyloid angiopathy remain at
higher risk for anticoagulant-related ICH recurrence than thromboembolic events and,
therefore would be best managed without anticoagulants. Patients with deep hemispheric
ICH and a baseline risk of ischemic stroke >6.5% per year, that corresponds to CHADS2 ≥ 4 or CHA2DS2-VASc ≥ 5, may receive net benefit from restarting anticoagulation. To date, a reasonable
recommendation regarding time to resumption of anticoagulation therapy would be after
10 weeks. Available data regarding the role of magnetic resonance imaging in assessing
the risks of both ICH and warfarin-related ICH do not support the use of this test
for excluding anticoagulation in patients with atrial fibrillation.
Keywords
Cerebral haemorrhage - warfarin - anticoagulants - atrial fibrillation