Optimal Antithrombotic Strategy for Atrial Fibrillation Patients with Prior Brain Hemorrhage

In a randomized trial comparing use of a direct oral anticoagulant versus no anticoagulant, ischemic stroke was reduced with DOAC treatment, but this was partially offset by a higher brain hemorrhage rate.

A common dilemma for clinicians in the management of patients with atrial fibrillation (AF) is balancing the risk for ischemic stroke with risk for major bleeding events such as intracerebral hemorrhage (ICH). This dilemma is magnified in patients with AF and prior ICH. More information on whether to use a direct oral anticoagulant (DOAC) in this population is welcome. In this open-label, randomized trial conducted between 2019 and 2023, patients with AF, a prior ICH, an indication for anticoagulation, and baseline modified Rankin Scale score ≤4 were randomized to DOAC therapy or no anticoagulation. Clinicians could select any DOAC medication. The two coprimary endpoints were first ischemic stroke and first recurrent ICH.

The trial included …

Reviewing Author

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Optimal Antithrombotic Strategy for Atrial Fibrillation Patients with Prior Brain Hemorrhage

Topics

Reviewing Author