AUTHOR=Lucà Fabiana , Colivicchi Furio , Oliva Fabrizio , Abrignani Maurizio , Caretta Giorgio , Di Fusco Stefania Angela , Giubilato Simona , Cornara Stefano , Di Nora Concetta , Pozzi Andrea , Di Matteo Irene , Pilleri Anna , Rao Carmelo Massimiliano , Parlavecchio Antonio , Ceravolo Roberto , Benedetto Francesco Antonio , Rossini Roberta , Calvanese Raimondo , Gelsomino Sandro , Riccio Carmine , Gulizia Michele Massimo TITLE=Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1061618 DOI=10.3389/fcvm.2023.1061618 ISSN=2297-055X ABSTRACT=

Intracranial hemorrhage (ICH) is considered a potentially severe complication of oral anticoagulants (OACs) and antiplatelet therapy (APT). Patients with atrial fibrillation (AF) who survived ICH present both an increased ischemic and bleeding risk. Due to its lethality, initiating or reinitiating OACs in ICH survivors with AF is challenging. Since ICH recurrence may be life-threatening, patients who experience an ICH are often not treated with OACs, and thus remain at a higher risk of thromboembolic events. It is worthy of mention that subjects with a recent ICH and AF have been scarcely enrolled in randomized controlled trials (RCTs) on ischemic stroke risk management in AF. Nevertheless, in observational studies, stroke incidence and mortality of patients with AF who survived ICH had been shown to be significantly reduced among those treated with OACs. However, the risk of hemorrhagic events, including recurrent ICH, was not necessarily increased, especially in patients with post-traumatic ICH. The optimal timing of anticoagulation initiation or restarting after an ICH in AF patients is also largely debated. Finally, the left atrial appendage occlusion option should be evaluated in AF patients with a very high risk of recurrent ICH. Overall, an interdisciplinary unit consisting of cardiologists, neurologists, neuroradiologists, neurosurgeons, patients, and their families should be involved in management decisions. According to available evidence, this review outlines the most appropriate anticoagulation strategies after an ICH that should be adopted to treat this neglected subset of patients.