ESOC 2022 | Trials assessing anticoagulation after ICH in patients with atrial fibrillation

Daniela Poli, MD, Azienda Ospedaliera Universitaria Careggi, Florence, Italy, shares an overview of clinical studies assessing restart of anticoagulation after intracranial hemorrhage (ICH). While data from observational studies has suggested that reinstitution of anticoagulation after ICH is associated with a lower risk of thromboembolic events and a similar risk of ICH recurrence, recent trial data does not support the benefit of restarting on ischemic stroke risk. APACHE-AF (NCT02565693) compared outcomes in patients with atrial fibrillation treated with apixaban compared with avoiding anticoagulation after intracerebral hemorrhage. No difference in risk of non-fatal stroke or vascular death was seen between the two groups. Similarly, data from the pilot SoStart trial (NCT03153150) assessing starting versus avoiding anticoagulation after ICH was inconclusive. The risk of thromboembolism due to anticoagulation cessation must be carefully balanced against the risk of recurrent ICH upon restart of anticoagulation and based on current data, the optimal approach is unclear. This interview took place at the ESOC 2022 congress in Lyon, France.