New information has become available to help guide clinicians on the thorny issue of oral anticoagulation in patients with atrial fibrillation (AF) who have had an intracranial hemorrhage (ICH).
The data come from a new meta-analysis of four small, randomized trials, and a warning from a fifth ongoing study about possible harm in certain patients.
"While the issue of whether to give oral anticoagulation to ICH patients with AF is still very uncertain, I think this new information will provide some helpful guidance on decision-making in these patients," lead author of the meta-analysis, Rustam Al-Shahi Salman, MD, professor of clinical neurology at the University of Edinburgh, UK, told theheart.org | Medscape Cardiology.
The meta-analysis shows oral anticoagulation was associated with a clear reduction in major ischemic cardiovascular events, and ischemic stroke, but, because of uncertainties about bleeding risk, and small numbers of patients, it was not possible to show a net clinical benefit.
Salman presented the meta-analysis at the World Stroke Conference (WSC) 2023, held last week in Toronto. It was also simultaneously published online in Lancet Neurology.
At the same time, investigators of a fifth still-ongoing study of oral anticoagulation in ICH patients with AF – the ENRICH-AF study – announced that the trial's data safety monitoring board has recommended that patients with two particular types of ICH (lobar intracranial hemorrhage and convexity subarachnoid hemorrhage) stop receiving the anticoagulant being tested (edoxaban) and that no further patients with these types of ICH be enrolled into the study because of an "unacceptably high risk of recurrent
