Which AFib Patients Should Resume Warfarin After Intracranial Hemorrhage?

MedicalResearch.com Interview with:
Peter Brønnum Nielsen MD PhD
Aalborg Thrombosis Research Unit
Department of Clinical Medicine
Faculty of Health
Department of Cardiology, Atrial Fibrillation Study Group
Aalborg University Hospital
Aalborg, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:   Patients who sustain an intracranial hemorrhage (ICH) event are often excluded from randomized trials investigating stroke prevention in atrial fibrillation (AF) by use of oral anticoagulant treatment.

MedicalResearch.com: What should readers take away from your report?

Response:  This is a treatment conundrum: what to do with these patients who have been taking oral anticoagulants for stroke prevention in atrial fibrillation but have suffered an ICH.

Obviously the medication is stopped during the acute event, but the question is whether it should be restarted later. Until now, there has not been much differentiation between the cause associated with the ICH, that is, traumatic induced ICH or spontaneous ICH – at least in terms of treatment recommendation.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response:  Patients who experienced a traumatic induced  intracranial hemorrhage or a spontaneous ICH event, the associated risk of resuming anticoagulant treatment suggested a reduction in ischemic events. Patients who sustained a traumatic intracranial hemorrhage did not have different rates of recurrence in comparison with patients who did not resume treatment. Patients who sustained a spontaneous intracranial hemorrhage event had higher rates of recurrence associated with treatment resumption.

MedicalResearch.com: Is there anything else you would like to add?

Response:  Patients with AF who sustain an  ntracranial hemorrhage event have different prognosis in relation to cause of the event.

Associated treatment resumption and outcomes is likewise different. Prescribing physicians and future trial designers should consider this treatment. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Nielsen PB, Larsen TB, Skjøth F, Lip GYH. Outcomes Associated With Resuming Warfarin Treatment After Hemorrhagic Stroke or Traumatic Intracranial Hemorrhage in Patients With Atrial Fibrillation. JAMA Intern Med. Published online February 20, 2017. doi:10.1001/jamainternmed.2016.9369

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Last Updated on February 25, 2017 by Marie Benz MD FAAD