Oral anticoagulant therapy in patients after intracerebral hemorrhage
https://doi.org/10.14412/2074-2711-2020-3-4-10
Abstract
The presence of indications for long-term oral anticoagulant (OAC) therapy in a patient who has experienced an intracerebral hemorrhage (IUD) poses a difficult clinical dilemma for the physician. The article discusses the vectors of recurrence for different types of IUD and their neuroimaging markers. It describes approaches to the global assessment of risk factors for IUD in patients taking OACs. Detailed consideration is given to the situation of IUD concurrent with atrial fibrillation as the most common reason for prescribing OACs. There are data on the safety of restating OACs after IUD and on the risk of the latter in patients taking warfarin and direct OACs. The optimal OAC start or restart time after IUD, including that in patients with prosthetic valves, is discussed. An algorithm for decision making is recommended.
About the Authors
A. A. KuleshRussian Federation
Aleksey Aleksandrovich Kulesh.
2, Kim St., Perm 614107.
Competing Interests: There are no conflicts of interest.
L. I. Syromyatnikova
Russian Federation
2, Kim St., Perm 614107.
Competing Interests: There are no conflicts of interest.
References
1. Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet. 2018 Oct 6;392(10154):1257-68. doi: 10.1016/S0140-6736(18)31878-6.
2. An SJ, Kim TJ, Yoon BW. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. J Stroke. 2017 Jan;19(1):3-10. doi: 10.5853/jos.2016.00864. Epub 2017 Jan 31.
3. Kuramatsu JB, Huttner HB. Management of oral anticoagulation after intracerebral hemorrhage. Int J Stroke. 2019 Apr;14(3):238-46. doi: 10.1177/1747493019828555. Epub 2019 Feb 14.
4. Purrucker JC, Steiner T. Atypical intracerebral hemorrhage-etiology and acute management. JAMA. 2013 Sep 25;310(12):1248-55. doi: 10.1001/jama.2013.278018.
5. Kulesh AA. Current approaches to diagnosing in intracerebral hemorrhage. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(2): 4-11. (In Russ.). doi: 10.14412/2074-27112020-2-4-11
6. Hostettler IC, Seiffge DJ, Werring DJ. Intracerebral hemorrhage: an update on diagnosis and treatment. Expert Rev Neurother. 2019 Jul;19(7):679-94. doi: 10.1080/14737175.2019.1623671. Epub 2019 Jun 12.
7. Roh D, Sun CH, Schmidt JM, et al. Primary Intracerebral Hemorrhage: A Closer Look at Hypertension and Cerebral Amyloid Angiopathy. Neurocrit Care. 2018 Aug;29(1):77-83. doi: 10.1007/s12028-018-0514-z.
8. Guidoux C, Hauw JJ, Klein IF, et al. Amyloid Angiopathy in Brain Hemorrhage: A Postmortem Neuropathological Magnetic Resonance Imaging Study. Cerebrovasc Dis. 2018;45(3-4):124-31. doi: 10.1159/000486554. Epub 2018 Mar 20.
9. Charidimou A, Martinez-Ramirez S, Reijmer YD, et al. Total Magnetic Resonance Imaging Burden of Small Vessel Disease in Cerebral Amyloid Angiopathy: An Imaging-Pathologic Study of Concept Validation. JAMA Neurol. 2016 Aug 1;73(8):994-1001. doi: 10.1001/jamaneurol.2016.0832.
10. Rodrigues MA, Samarasekera N, Lerpiniere C, et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol. 2018 Mar; 17(3):232-40. doi: 10.1016/S1474-4422(18)30006-1. Epub 2018 Jan 10.
11. Kulesh AA, Drobakha VE, Shestakov VV. Hemorrhagic manifestations of cerebral amyloid angiopathy: from pathogenesis to clinical significance. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):4-11. (In Russ.). doi: 10.14412/2074-2711-2018-3-4-11
12. Novosadova OA, Grigor'eva VN. Cerebral amyloid angiopathy and hypertensive cerebral microangiopathy. Differential diagnosis. Nevrologicheskii vestnik. 2019;51(2):72-9. (In Russ).
13. Tsai HH, Pasi M, Tsai LK, et al. Superficial Cerebellar Microbleeds and Cerebral Amyloid Angiopathy: A Magnetic Resonance Imaging/ Positron Emission Tomography Study. Stroke. 2020 Jan;51(1):202-208. doi: 10.1161/STROKEAHA.119.026235. Epub 2019 Nov 15.
14. Biffi A, Anderson CD, Battey TW, et al. Association between blood pressure control and risk of recurrent intracerebral hemorrhage. JAMA. 2015 Sep 1;314(9):904-12. doi: 10.1001/jama.2015.10082.
15. Charidimou A, Imaizumi T, Moulin S, et al. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology. 2017 Aug 22;89(8):820-29. doi: 10.1212/WNL.0000000000004259. Epub 2017 Jul 26.
16. Casolla B, Moulin S, Kyheng M, et al. Five-Year Risk of Major Ischemic and Hemorrhagic Events After Intracerebral Hemorrhage. Stroke. 2019 May;50(5):1100-07. doi: 10.1161/STROKEAHA.118.024449.
17. Petrault M, Casolla B, Ouk T, et al. Cerebral microbleeds: Beyond the macroscope. Int J Stroke. 2019 Jul;14(5):468-475. doi: 10.1177/1747493019830594. Epub 2019 Feb 12.
18. Charidimou A, Linn J, Vernooij MW, et al. Cortical superficial siderosis: detection and clinical significance in cerebral amyloid angiopathy and related conditions. Brain. 2015 Aug;138(Pt 8):2126-39. doi: 10.1093/brain/awv162. Epub 2015 Jun 26.
19. Charidimou A, Boulouis G, Roongpiboonsopit D, et al. Cortical superficial siderosis and recurrent intracerebral hemorrhage risk in cerebral amyloid angiopathy: Large prospective cohort and preliminary meta-analysis. Int J Stroke. 2019 Oct;14(7):723-733. doi: 10.1177/1747493019830065. Epub 2019 Feb 20.
20. Charidimou A, Zonneveld HI, Shams S, et al. APOE and cortical superficial siderosis in CAA: Meta-analysis and potential mechanisms. Neurology. 2019 Jul 23;93(4):e358-e371. doi: 10.1212/WNL.0000000000007818. Epub 2019 Jun 26.
21. ESC Guidelines for the treatment of patients with atrial fibrillation developed in conjunction with EACTS. Rossiiskii kardiologicheskii zhur-nal. 2017;(7):7-86. (In Russ.).
22. Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhytm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018 Apr 21; 39(16):1330-1393. doi: 10.1093/eurheartj/ehy136.
23. Resolution of the Eurasian Association of therapists. Algorithm for evaluating and modifying risk factors for small bleeding in patients with atrial fibrillation receiving POAC therapy. 2019. (In Russ.).
24. Wilson D, Ambler G, Shakeshaft C, et al; CROMIS-2 Collaborators. Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol. 2018 Jun;17(6):539-47. doi: 10.1016/S1474-4422(18)30145-5. Epub 2018 May 16.
25. Hilkens NA, Algra A, Greving JP. Predicting major bleeding in ischemic stroke patients with atrial fibrillation. Stroke. 2017 Nov;48(11):3142-44. doi: 10.1161/STROKEAHA.117.019183. Epub 2017 Sep 20.
26. Steiner T, Weitz JI, Veltkamp R. Anticoagulant-Associated Intracranial Hemorrhage in the Era of Reversal Agents. Stroke. 2017 May;48(5):1432-1437. doi: 10.1161/STROKEAHA.116.013343. Epub 2017 Apr 11.
27. Marti-Fabregas J, Medrano-Martorell S, Merino E, et al. MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation. Neurology. 2019 May 21;92(21):e2432-e2443. doi: 10.1212/WNL.0000000000007532. Epub 2019 Apr 19.
28. Kaiser J, Schebesch KM, Brawanski A, et al. Long-Term Follow-Up of Cerebral Amyloid Angiopathy-Associated Intracranial Hemorrhage Reveals a High Prevalence of Atrial Fibrillation. J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104342. doi: 10.1016/j.jstroke-cerebrovasdis.2019.104342. Epub 2019 Sep 11.
29. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016 Nov;18(11): 1609-78. Epub 2016 Aug 27.
30. Tomaselli GF, Mahaffey KW, Cuker A, et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants. J Am Coll Cardiol. 2017 Dec 19; 70(24):3042-3067. doi: 10.1016/j.jacc.2017.09.1085. Epub 2017 Dec 1.
31. Niessner A, Tamargo J, Morais J, et al. Reversal strategis for no-vitamin K antagonist oral anticoagulants: a critical appraisal of available evidence and recommendatios for clinical management — a joint position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2017 Jun 7; 38(22):1710-1716. doi: 10.1093/eurheartj/ehv676.
32. Labaf A, Grzymala-Lubanski B, Stagmo M, et al. Thromboembolism, major bleeding and mortality in patients with mechanical heart valves — a population-based cohort study. Thromb Res. 2014 Aug;134(2):354-9. doi: 10.1016/j.thromres.2014.06.007. Epub 2014 Jun 12.
33. Halvorsen S, Storey RF, Rocca B, et al. Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2017 May 14;38(19):1455-1462. doi: 10.1093/eurheartj/ehw454.
34. Xu Y, Shoamanesh A, Schulman S, et al. Oral anticoagulant reinitiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts. PLoS One. 2018 Jan 25;13(1):e0191137. doi: 10.1371/journal.pone.0191137. eCollection 2018.
35. Majeed A, Kim YK, Roberts RS, et al. Optimal timing of resumption of warfarin after intracranial hemorrhage. Stroke. 2010 Dec;41(12): 2860-6. doi: 10.1161/STROKEAHA.110.593087. Epub 2010 Oct 28.
36. Poli D, Antonucci E, Dentali F, et al. Recurrence of ICH after resumption of anticoagulation with VK antagonists: CHIRONE study. Neurology. 2014 Mar 25;82(12):1020-6. doi: 10.1212/WNL.0000000000000245. Epub 2014 Feb 21.
37. Yung D, Kapral MK, Asllani E, et al. Reinitiation of anticoagulation after warfarin-associated intracranial hemorrhage and mortality risk: the Best Practice for Reinitiating Anticoagulation Therapy After Intracranial Bleeding (BRAIN) study. Can J Cardiol. 2012 Jan-Feb;28(1):33-9. doi: 10.1016/j.cjca.2011.10.002. Epub 2011 Dec 7.
38. Kuramatsu JB, Gerner ST, Schellinger PD, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA. 2015 Feb 24;313(8):824-36. doi: 10.1001/jama.2015.0846.
39. Nielsen PB, Larsen TB, Skjoth F, et al. Restarting anticoagulant treatment after intracranial hemorrhage in patients with atrial fibrillation and the impact on recurrent stroke, mortality, and bleeding: a nationwide cohort study. Circulation. 2015 Aug 11;132(6):517-25. doi: 10.1161/CIRCULATIONAHA.115.015735. Epub 2015 Jun 9.
40. Poli L, Grassi M, Zedde M, et al. Anticoagulants Resumption after Warfarin-Related Intracerebral Haemorrhage: The Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy). Thromb Haemost. 2018;118(3):572-80.
41. Chai-Adisaksopha C, Iorio A, Hillis C, et al. Warfarin resumption following anticoagulant-associated intracranial hemorrhage: a systematic review and meta-analysis. Thromb Res. 2017 Dec;160:97-104. doi: 10.1016/j.throm-res.2017.11.001. Epub 2017 Nov 11.
42. Zhou Z, Yu J, Carcel C, et al. Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis. BMJ Open. 2018 May 14; 8(5):e019672. doi: 10.1136/bmjopen-2017-019672.
43. Murthy SB, Gupta A, Merkler AE, et al. Restarting anticoagulant therapy after intracranial hemorrhage: a systematic review and metaanalysis. Stroke. 2017 Jun;48(6):1594-1600. doi: 10.1161/STROKEAHA.116.016327. Epub 2017 Apr 17.
44. Biffi A, Kuramatsu JB, Leasure A, et al. Oral anticoagulation and functional outcome after intracerebral hemorrhage. Ann Neurol. 2017;82:755-65.
45. Perreault S, Cote R, White-Guay B, et al. Anticoagulants in Older Patients with Nonvalvular Atrial Fibrillation after Intracranial Hemorrhage. J Stroke. 2019 May;21(2): 195-206. doi: 10.5853/jos.2018.02243. Epub 2019 May 31.
46. Yanishevskii SN. Intracranial hemorrhage in patients taking oral anticoagulants. Current possibilities for therapy. Nevrologiya, neirop-sikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S): 82-8. (In Russ.). doi: 10.14412/2074-2711-2019-3S-82-88
47. Nielsen PB, Skj0th F, S0gaard M, et al. Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Atrial Fibrillation Patients With Intracerebral Hemorrhage. Stroke. 2019 Apr;50(4):939-46. doi: 10.1161/STROKEAHA.118.023797.
48. Sumarokov AB, Buryachkovskaya LI, Lomakin NV. Specific antidotes for direct oral anticoagulants for life-threatening bleeding. Ratsional'naya Farmakoterapiya v Kardiologii. 2018;14(6):944-50. (In Russ.).
49. Pollack CV, Reilly PA, van Ryn J, et al. Idarubicizumab for dabigatran reversal — full cohort analysis. N Engl J Med. 2017 Aug 3;377(5): 431-441. doi: 10.1056/NEJMoa1707278. Epub 2017 Jul 11.
50. Domashenko MA. Hemorrhagic stroke and oral anticoagulants: What is to be done? Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(1):61-70. (In Russ.). doi: 10.14412/2074-2711-2016-1-61-70
51. Sakamoto Y, Nito C, Nishiyama Y, et al. Safety of Anticoagulant Therapy Including Direct Oral Anticoagulants in Patients With Acute Spontaneous Intracerebral Hemorrhage. Circ J. 2019 Jan 25;83(2):441-6. doi: 10.1253/circj.CJ-18-0938. Epub 2018 Dec 27.
52. Kato Y, Hayashi T, Suzuki K, et al. Resumption of Direct Oral Anticoagulants in Patients with Acute Spontaneous Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104292. doi: 10.1016/j.jstrokecere-brovasdis.2019.07.008. Epub 2019 Jul 30.
53. Pennlert J, Overholser R, Asplund K, et al. Optimal timing of anticoagulant treatment after intracerebral hemorrhage in patients with atrial fibrillation. Stroke. 2017 Feb;48(2):314-20. doi: 10.1161/STROKEAHA.116.014643. Epub 2016 Dec 20.
54. Li YG, Lip GYH. Anticoagulation Resumption After Intracerebral Hemorrhage. Review. Curr Atheroscler Rep. 2018 May 21; 20(7):32. doi: 10.1007/s11883-018-0733-y.
55. Kuramatsu JB, Sembill JA, Gerner ST, et al. Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves. Eur Heart J. 2018 May 14;39(19):1709-23. doi: 10.1093/eurheartj/ehy056.
56. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017 Sep 21;38(36):2739-91. doi: 10.1093/eurheartj/ehx391.
57. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2019 Jul 9;140(2):e125-e151. doi: 10.1161/CIR.0000000000000665. Epub 2019 Jan 28
Review
For citations:
Kulesh AA, Syromyatnikova LI. Oral anticoagulant therapy in patients after intracerebral hemorrhage. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(3):4-10. https://doi.org/10.14412/2074-2711-2020-3-4-10