Antiplatelet and anticoagulant therapy after intracerebral hemorrhage

Abstract

Management of patients with an indication for long-term oral antithrombotic therapy who have an intracerebral hemorrhage (ICH) presents a therapeutic dilemma. Should antithrombotic therapy be resumed, and if so, when, using what agent, and for whom? There is no consensus for answers to these questions. In the absence of randomized trials, management of antithrombotic therapy after ICH is based on a combination of observational data, pathophysiologic concepts, and decision analysis. At the heart of the decision is an assessment of the individual patient's risk of thromboembolism off antithrombotic therapy versus risk of ICH recurrence on antithrombotic therapy.

Keywords: Anticoagulation; Antiplatelet therapy; Atrial fibrillation; Intracerebral hemorrhage; Prosthetic heart valve; Venous thromboembolism.