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Observational study
In patients with intracerebral haemorrhage and concomitant atrial fibrillation, optimal timing of reinitiating anticoagulants may be 7–8 weeks after ICH
  1. Catharina JM Klijn,
  2. Floris HBM Schreuder
  1. Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Prof. Catharina JM Klijn, Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, Nijmegen 6500 HB, The Netherlands; karin.klijn{at}radboudumc.nl

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Commentary on: Pennlert J, et al. Optimal timing of anticoagulant treatment after intracerebral haemorrhage in patients with atrial fibrillation. Stroke 2017:48;314–320.

Context

In patients with intracerebral haemorrhage (ICH) and a concomitant diagnosis of atrial fibrillation (AF), the clinical dilemma arises whether anticoagulant treatment should be (re)started and when.1 In the absence of results from randomised controlled trials, guidelines provide no firm recommendations. Several observational studies have suggested that reintroduction of oral anticoagulants may be associated with a reduction in thrombotic events and all-cause mortality.2 3 Evidence regarding the optimal timing of reinitiating anticoagulant treatment is even scarcer.

Methods

This was a nationwide observational study of 2619 patients with ICH (mean age 78.0 years) with a concomitant diagnosis of AF identified in the Swedish stroke register, Riksstroke, who survived hospital discharge. Patient characteristics, prescribed drugs after ICH and outcomes were extracted from various national databases. Primary outcome was …

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