Does restarting anticoagulation prevent ischemic stroke and reduce mortality in ICH survivors with NVAF?
While current observational data suggest a net benefit for restarting anticoagulation in NVAF patients after an ICH, randomized controlled trials are needed to provide conclusive answers free of selection bias.
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. However, those studies are observational and mostly retrospective, therefore selection bias may play a major role in the results observed in these cohorts. Only randomized controlled trials, either pragmatic or explanatory, can provide more conclusive answers for this important clinical question.
Hawkes et al. (2018) studied this question.