In addition , 19 letters to the editor/ review s/editorials/experts ' surveys/experts ' opinion were used for discussion purpose s. Conclusions NVAF is highly prevalent among ICH survivors .
The risks of IS , recurrent ICH , and mortality are heightened in this group .
Most published data show a net benefit in terms of IS prevention and mortality when anticoagulation is restarted .
Background We summarize the existing evidence on the potential benefit of oral anticoagulation ( OAC ) in intracerebral hemorrhage ( ICH ) survivors with nonvalvular atrial fibrillation ( NVAF ) .
Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk.
SUMMARY BACKGROUND Patients who present with central nervous system ( CNS ) hemorrhage while on anticoagulation ( AC ) for thromboembolic ( TE ) risk factors are a challenge to manage . OBJECTIVE We sought to inform decisions surrounding the timing and intensity of AC resumption by performing a systematic review . METHODS Three review ers screened publications from Medline and EMBASE and extracted data . Hemorrhagic and TE adverse events that occurred subsequent to the index hemorrhage were recorded , as was their timing relative to presentation and covariates that might influence their occurrence . RESULTS Data were extracted from 63 publications detailing 492 patients ; 7.7 % of patients experienced hemorrhagic complications and 6.1 % experienced TE complications . Hemorrhagic complications were more common within 72 h of presentation while TE complications were more common thereafter . Patients restarted on AC after 72 h were significantly more likely to have a TE complication ( P = 0.006 ) and those restarted before 72 h were more likely to hemorrhage ( P = 0.0727 ) . Factors associated with re-hemorrhage included younger age , traumatic cause , subdural hematomas and failure to reverse AC . TE complications were more common in younger patients and those with spinal hemorrhage , multiple hemorrhages , and non-traumatic causes of the index hemorrhage . Re-initiation of AC at a lower intensity also significantly increased the risk of TE complications . INTERPRETATION Our results suggest that it may be prudent to re-initiate AC earlier than previously thought , with the timing and intensity modified based on predictors of TE and hemorrhagic complications . These findings must be explored in a prospect i ve study because of limitations inherent to the analyzed studies
In addition , 19 letters to the editor/ review s/editorials/experts ' surveys/experts ' opinion were used for discussion purpose s. Conclusions NVAF is highly prevalent among ICH survivors .
The risks of IS , recurrent ICH , and mortality are heightened in this group .
Most published data show a net benefit in terms of IS prevention and mortality when anticoagulation is restarted .
Background We summarize the existing evidence on the potential benefit of oral anticoagulation ( OAC ) in intracerebral hemorrhage ( ICH ) survivors with nonvalvular atrial fibrillation ( NVAF ) .