OAC Medication in Patients With AF Who Survived Intracranial Hemorrhage

In a study in Stroke, researchers examined the efficacy and safety of oral anticoagulants (OACs) and antiplatelets in patients with atrial fibrillation who survived an intracranial hemorrhage (ICrH). After analyses, the study’s authors concluded that OAC medications were effective for managing cardiovascular risk without increasing ICrH recurrence risk.

The meta-analysis included 50,470 patients from 20 studies: 2 randomized controlled trials, 8 observational studies, 8 cohort studies, and 2 meta-analyses of observational studies. The inclusion criteria were adults with atrial fibrillation and spontaneous ICrH who were taking antithrombotic medication to prevent stroke.

OACs Appear Safe and Effective in Post-ICrH Patients with AF

According to the researchers, treatment with OAC medication was associated with a significant reduction in thromboembolic events (summary relative risk [sRR], 0.51; 95% confidence interval [CI], 0.30–0.86; I2=2%; P=.39; n=5 studies) and all-cause mortality (sRR, 0.52; 95% CI, 0.38–0.71; I2=0%; P=.44; n=3 studies). Additionally, OACs were not associated with increased risk for ICrH recurrence (sRR, 1.44; 95% CI, 0.38–5.46; I2=70%; P=.02; n=5 studies).

The authors also noted that non-vitamin K antagonist OACs more effectively reduced risk for thromboembolic events (sRR, 0.65; 95% CI, 0.44–0.97; I2=72%; P=.03; n=3 studies) and had a lower risk of recurrent ICrH (SR, 0.52; 95% CI, 0.40–0.67; I2=0%; P=.03; n=3 studies) compared with warfarin.

Ultimately, the authors judged that OAC medications were safe and effective for reducing thromboembolic risk in high-risk patients with atrial fibrillation who survived ICrH.

However, they acknowledged that their findings are “primarily based on observational data, and further larger randomized controlled trials are needed to corroborate or refute these findings.”

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