A review of the use of oral anticoagulants in individuals with atrial fibrillation who had experienced intracranial hemorrhage in the past.

Abstract

Atrial fibrillation (AF) is the most prevalent arrhythmia, significantly increasing the risk of stroke and thromboembolism. Oral anticoagulants (OACs), including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), have been shown to reduce these risks effectively. However, the administration of OACs carries a notable risk of spontaneous intracranial hemorrhage (ICH), a severe complication associated with high morbidity and mortality. Patients with a history of ICH face a complex decision regarding the resumption of anticoagulation therapy, as the likelihood of recurrence is heightened in this population. Current literature reveals inconsistencies in research findings regarding the safety and efficacy of restarting OACs after ICH. A lack of definitive guidelines addressing this issue leaves clinicians uncertain about optimal management strategies. This systematic review aims to analyze existing observational studies and randomized controlled trials (RCTs) to evaluate the safety and effectiveness of resuming OACs in patients with AF who have experienced ICH. The review underscores the urgent need for high-quality research to inform clinical practices and develop comprehensive guidelines for managing anticoagulation therapy in this vulnerable group.