New information has become available to help guide clinicians on the thorny issue of whether to give oral anticoagulation to patients with AF who have had an intracranial hemorrhage.
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Salman explained that while oral anticoagulation has been known for many years to have a clear and powerful benefit in preventing ischemic strokes for patients with AF, whether oral anticoagulation would also be beneficial in AF patients who have had an ICH is not at all clear. The meta-analysis was conducted by the investigators involved in the four completed trials as a group known as COCROACH .— comparing oral anticoagulation with control patients who avoided oral anticoagulation .The primary outcome of any stroke or cardiovascular death occurred in 14% of those on oral anticoagulation vs 22% of controls, with a pooled hazard ratio of 0.68 .
"Our main finding was that oral anticoagulation reduces the risk of ischemic cardiovascular events in this patient group," Salman commented."We showed a clear benefit there. But all the other findings were neutral, and we couldn't show a definite net effect on any stroke or cardiovascular death. But nor did we find a significant increase in the risk of bleeding, which is important because we first worry about harm.
"We didn’t identify a major hazard or a major benefit in any particular subgroup, and we did not see any hints of the harms found in the ENRICH-AF trial in patients with lobar or convexitySalman suggested that applying the evidence to individuals will involve weighing up risks and benefits.
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