Improved Oral Anticoagulation for AF Patients with ICH: Promising Findings
New data from a meta-analysis of four small randomized trials and an ongoing study provide guidance on the use of oral anticoagulation in patients with atrial fibrillation (AF) who have had an intracranial hemorrhage (ICH). The meta-analysis showed that oral anticoagulation reduced the risk of ischemic major adverse cardiovascular events and ischemic stroke, but uncertainties about bleeding risk and small patient numbers prevented a definitive conclusion on net clinical benefit. The ongoing study, ENRICH-AF, reported an "unacceptably high risk of recurrent hemorrhagic stroke" in certain ICH patients receiving the anticoagulant being tested. Clinicians should weigh the risks and benefits on an individual basis, considering factors such as bleeding risk and stroke risk. Randomized trials are ongoing to provide clearer results in the future.
