Oral anticoagulant therapy in patients after intracerebral hemorrhage

Abstract

The presence of indications for long-term oral anticoagulant (OAC) therapy in a patient who has experienced an intracerebral hemorrhage (IUD) poses a difficult clinical dilemma for the physician. The article discusses the vectors of recurrence for different types of IUD and their neuroimaging markers. It describes approaches to the global assessment of risk factors for IUD in patients taking OACs. Detailed consideration is given to the situation of IUD concurrent with atrial fibrillation as the most common reason for prescribing OACs. There are data on the safety of restating OACs after IUD and on the risk of the latter in patients taking warfarin and direct OACs. The optimal OAC start or restart time after IUD, including that in patients with prosthetic valves, is discussed. An algorithm for decision making is recommended.

Keywords

• intracerebral hemorrhage
• cerebral amyloid angiopathy
• cerebral microbleeding
• cortical superficial siderosis
• oral anticoagulants