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Hemorrhagic stroke and oral anticoagulants: What is to be done?

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Hemorrhagic stroke (HS) is associated with high mortality and disability rates. Due to the introduction of the current guidelines for the prevention of systemic thromboembolic events in patients with atrial fibrillations and to an increase in the number of older patients, there has been a rise in the incidence of intracranial hemorrhage (ICH) associated with the use of oral anticoagulants. The paper discusses medical treatment in patients with HS during therapy with vitamin K antagonists (warfarin) and novel oral anticoagulants (dabigatran. rivaroxaban, apixaban), as well as an anticoagulant resumption policy after prior ICH in patients at high risk for thromboembolic events.

About the Author

M. A. Domashenko
Neurology Research Center, Moscow, Russia 80, Volokolamskoe Shosse, Moscow 125367
Russian Federation


1. Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009 Apr;8(4):355-69. doi: 10.1016/S1474- 4422(09)70025-0. Epub 2009 Feb 21.

2. Steiner T, Al-Shahi Salman R, Beer R, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014 Oct;9(7):840-55. doi: 10.1111/ijs.12309. Epub 2014 Aug 24.

3. van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010 Feb;9(2):167-76. doi: 10.1016/S1474- 4422(09)70340-0. Epub 2010 Jan 5.

4. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014 Jan 18;383(9913):245-54.

5. Poon MT, Fonville AF, Al-Shahi Salman R. Long-term prognosis after intracerebral haemorrhage: systematic review and metaanalysis. J Neurol Neurosurg Psychiatry. 2014 Jun;85(6):660-7. doi: 10.1136/jnnp-2013- 306476. Epub 2013 Nov 21.

6. Hart RG, Pearce LA, Aguilar MI. Metaanalysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007 Jun 19;146(12):857-67.

7. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A metaanalysis of randomised trials. Lancet. 2014 Mar 15;383(9921):955-62. doi: 10.1016/S0140- 6736(13)62343-0. Epub 2013 Dec 4.

8. Chiang CE, Wang KL, Lip GY. Stroke prevention in atrial fibrillation: an Asian perspective. Thromb Haemost. 2014 May 5;111(5): 789-97. doi: 10.1160/TH13-11-0948. Epub 2014 Feb 6.

9. Radberg JA, Olsson JE, Radberg CT. Prognostic parameters in spontaneous intracerebral hematomas with special reference to anticoagulant treatment. Stroke. 1991 May;22(5):571-6.

10. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009 Sep 17;361(12):1139-51. doi: 10.1056/NEJMoa0905561. Epub 2009 Aug 30.

11. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011 Sep 8;365(10):883-91. doi: 10.1056/NEJMoa1009638. Epub 2011 Aug 10.

12. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11):981-92. doi: 10.1056/NEJMoa1107039. Epub 2011 Aug 27.

13. Chan NC, Paikin JS, Hirsh J, et al. New oral anticoagulants for stroke prevention in atrial fibrillation: impact of study design, double counting and unexpected findings on interpretation of study results and conclusions. Thromb Haemost. 2014 May 5;111(5):798-807. doi: 10.1160/TH13-11-0918. Epub 2014 Feb 20.

14. Hankey GJ. Intracranial hemorrhage and novel anticoagulants for atrial fibrillation: what have we learned? Curr Cardiol Rep. 2014 May;16(5):480. doi: 10.1007/s11886-014-0480-9.

15. Nielsen PB, Larsen TB, Skjoth F, et al. Restarting anticoagulant treatment after intracranial haemorrhage 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.

16. Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012 Jun;33(12):1500-10. doi: 10.1093/eurheartj/ ehr488. Epub 2012 Jan 13.

17. Nielsen PB, Larsen TB, Gorst-Rasmussen A, et al. Intracranial haemorrhage and subsequent ischemic stroke in patients with atrial fibrillation: A nationwide cohort study. Chest. 2015 Jun;147(6):1651-8. doi: 10.1378/chest.14-2099.

18. Flynn R, MacDonald TM, Murray GD, Doney AS. Systematic review of observational research studying the long-term use of antithrombotic medicines following intracerebral hemorrhage. Cardiovasc Ther. 2010 Jun;28(3):177-84. doi: 10.1111/j.1755- 5922.2009.00118.x. Epub 2010 Mar 7.

19. Flynn R, Doney A. Antithrombotic medicines following intracerebral haemorrhage: where’s the evidence? Ther Adv Drug Saf. 2011 Oct;2(5):205-11. doi: 10.1177/ 2042098611415457.

20. 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.

21. Marsh EB, Gottesman RF. Brain hemorrhage: restarting anticoagulation after intracranial hemorrhage. Nat Rev Neurol. 2011 Mar;7(3):130-2. doi: 10.1038/nrneurol.2011.6.Epub 2011 Feb 8.

22. Hemphill JC, Bonovich DC, Besmertis L, et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001 Apr;32(4):891-7.

23. Aguilar MI, Hart RG, Kase CS, et al. Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion. Mayo Clin Proc. 2007 Jan;82(1):82-92.

24. Brouwers HB, Greenberg SM. Hematoma expansion following acute intracerebral hemorrhage. Cerebrovasc Dis. 2013;35(3):195-201. doi: 10.1159/000346599. Epub 2013 Feb 28.

25. Dowlatshahi D, Butcher KS, Asdaghi N, et al. Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal. Stroke. 2012 Jul;43(7):1812-7. doi: 10.1161/STROKEAHA.112.652065. Epub 2012 May 3.

26. 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.

27. Heidbuchel H,Verhamme P, Alings M, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2013 May;15(5):625-51. doi: 10.1093/ europace/eut083.

28. Hankey GJ, Norrving B, Hacke W, Steiner T. Management of acute stroke in patients taking novel oral anticoagulants. Int J Stroke. 2014 Jul;9(5):627-32. doi: 10.1111/ijs.12295. Epub 2014 Jun 2.

29. Desmettre T, Dubart AE, Capellier G, et al. Emergency reversal of anticoagulation: the real use of prothrombin complex concentrates: a prospective multicenter two year French study from 2006 to 2008. Thromb Res. 2012 Sep;130(3):e178-83. doi: 10.1016/j.thromres. 2012.05.029. Epub 2012 Jun 21.

30. Heidbuchel H, Verhamme P, Alings M. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with nonvalvular atrial fibrillation. Europace. 2015 Oct;17(10):1467-507. doi: 10.1093/europace/euv309. Epub 2015 Aug 31.

31. Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Jul;46(7):2032-60. doi: 10.1161/STR.0000000000000069. Epub 2015 May 28.

32. Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e152S-84S. doi: 10.1378/chest.11-2295.

33. Hanley JP. Warfarin reversal. J Clin Path ol. 2004 Nov;57(11):1132-9.

34. Steiner T, Rosand J, Diringer M. Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and unresolved questions. Stroke. 2006 Jan;37(1):256-62. Epub 2005 Dec 8.

35. Dentali F, Ageno W, Crowther M. Treatment of coumarin-associated coagulopathy: a systematic review and proposed treatment algorithms. J Thromb Haemost. 2006 Sep;4(9):1853-63.

36. Goldstein JN, Thomas SH, Frontiero V, et al. Timing of fresh frozen plasma administration and rapid correction of coagulopathy in warfarin- related intracerebral hemorrhage. Stroke. 2006 Jan;37(1):151-5. Epub 2005 Nov 23.

37. Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol. 2008 Feb;83(2):137-43.

38. Pabinger I, Brenner B, Kalina U, et al. Prothrombin complex concentrate (Beriplex P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial. J Thromb Haemost. 2008 Apr;6(4):622-31. doi: 10.1111/j.1538-7836.2008.02904.x. Epub 2008 Jan 15.

39. Riess HB, Meier-Hellmann A, Motsch J, et al. Prothrombin complex concentrate (Octaplex) in patients requiring immediate reversal of oral anticoagulation. Thromb Res. 2007;121(1):9-16. Epub 2007 Apr 3.

40. Sarode R, Milling TJ, Refaai MA, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation. 2013 Sep 10;128(11):1234-43. doi: 10.1161/CIRCULATIONAHA. 113.002283. Epub 2013 Aug 9.

41. Lin J, Hanigan WC, Tarantino M, Wang J. The use of recombinant activated factor VII to reverse warfarin-induced anticoagulation in patients with hemorrhages in the central nervous system: preliminary findings. J Neurosurg. 2003 Apr;98(4):737-40.

42. Ilyas C, Beyer GM, Dutton RP, et al. Recombinant factor VIIa for warfarin-associated intracranial bleeding. J Clin Anesth. 2008 Jun;20(4):276-9. doi: 10.1016/j.jclinane. 2007.12.012.

43. Tanaka KA, Szlam F, Dickneite G, Levy JH. Effects of prothrombin complex concentrate and recombinant activated factor VII on vitamin K antagonist induced anticoagulation. Thromb Res. 2008;122(1):117-23. Epub 2007 Oct 31.

44. Rosovsky RP, Crowther MA. What is the evidence for the off-label use of recombinant factor VIIa (rFVIIa) in the acute reversal of warfarin? ASH evidence-based review 2008. Hematology Am Soc Hematol Educ Program. 2008:36-8. doi: 10.1182/asheducation-2008.1.36.

45. Majeed A, Schulman S. Bleeding and antidotes in new oral anticoagulants. Best Pract Res Clin Haematol. 2013 Jun;26(2):191-202. doi: 10.1016/j.beha.2013.07.001. Epub 2013 Jul 21.

46. Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015 Aug 6;373(6):511-20. doi: 10.1056/NEJMoa1502000. Epub 2015 Jun 22.

47. Levi M, Eerenberg E, Kamphuisen PW. Bleeding risk and reversal strategies for old and new anticoagulants and antiplatelet agents. J Thromb Haemost. 2011 Sep;9(9):1705-12. doi: 10.1111/j.1538-7836.2011.04432.x.

48. Kaatz S, Kouides PA, Garcia DA, et al. Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors. Am J Hematol. 2012 May;87 Suppl 1:S141-5. doi: 10.1002/ajh.23202. Epub 2012 Apr 4.

49. Zhou W, Schwarting S, Illanes S, et al. Hemostatic therapy in experimental intracerebral hemorrhage associated with the direct thrombin inhibitor dabigatran. Stroke. 2011 Dec;42(12):3594-9. doi: 10.1161/STROKEAHA. 111.624650. Epub 2011 Oct 13.

50. Dager WE, Gosselin RC, Roberts AJ. Reversing dabigatran in life-threatening bleeding occurring during cardiac ablation with factor eight inhibitor bypassing activity. Crit Care Med. 2013 May;41(5):e42-6. doi: 10.1097/CCM.0b013e31827caaa3.

51. Eerenberg ES, Kamphuisen PW, Sijpkens MK, et al. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo-controlled, crossover study in healthy subjects. Circulation. 2011 Oct 4;124(14): 1573-9. doi: 10.1161/CIRCULATIONAHA. 111.029017. Epub 2011 Sep 6.

52. Lazo-Langner A, Lang ES, Douketis J. Clinical review: clinical management of new oral anticoagulants: a structured review with emphasis on the reversal of bleeding complications. Crit Care. 2013 Jun 17;17(3):230. doi: 10.1186/cc12592.

53. Oh JJ, Akers WS, Lewis D, et al. Recombinant factor VIIa for refractory bleeding after cardiac surgery secondary to anticoagulation with the direct thrombin inhibitor lepirudin. Pharmacotherapy. 2006 Apr;26(4):569-577.

54. Flynn RW, MacDonald TM, Murray GD, et al. Prescribing antiplatelet medicine and subsequent events after intracerebral hemorrhage. Stroke. 2010 Nov;41(11):2606-11. doi: 10.1161/STROKEAHA.110.589143. Epub 2010 Oct 14.

55. Chandra D, Gupta A, Grover V, Kumar GV. When should you restart anticoagulation in patients who suffer an intracranial bleed who also have a prosthetic valve? Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):520-3. doi: 10.1093/icvts/ivs545. Epub 2013 Jan 3.

56. Claassen DO, Kazemi N, Zubkov AY, et al. Restarting anticoagulation therapy after warfarin- associated intracerebral hemorrhage. Arch Neurol. 2008 Oct;65(10):1313-8. doi: 10.1001/archneur.65.10.1313.

57. Masotti L, Godoy DA, Napoli MD, et al. Pharmacological prophylaxis of venous thromboembolism during acute phase of spontaneous intracerebral hemorrhage: what do we know about risks and benefits? Clin Appl Thromb Hemost. 2012 Jul;18(4):393-402. doi: 10.1177/1076029612441055. Epub 2012 May 19.

58. Yung D, Kapral MK, Asllani E, et al. Reinitiation of anticoagulation after warfarinassociated 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.

59. Romualdi E, Micieli E, Ageno W, Squizzato A. Oral anticoagulant therapy in patients with mechanical heart valve and intracranial haemorrhage. A systematic review. Thromb Haemost. 2009 Feb;101(2):290-7.

60. Paciaroni M, Agnelli G. Should oral anticoagulants be restarted after warfarin-associated cerebral haemorrhage in patients with atrial fibrillation? Thromb Haemost. 2014 Jan;111(1):14-8. doi: 10.1160/TH13-08-0667. Epub 2013 Nov 21.

61. Goldstein JN, Greenberg SM. Should anticoagulation be resumed after intracerebral hemorrhage? Cleve Clin J Med. 2010 Nov; 77(11):791-9. doi: 10.3949/ccjm.77a.10018.

62. Horstmann S, Rizos T, Jenetzky E, et al. Prevalence of atrial fibrillation in intracerebral hemorrhage. Eur J Neurol. 2014 Apr;21(4):570-6. doi: 10.1111/ene.12215. Epub 2013 Jun 12.

63. Arima H, Tzourio C, Butcher K, et al. Prior events predict cerebrovascular and coronary outcomes in the PROGRESS trial. Stroke. 2006 Jun;37(6):1497-502. Epub 2006 Apr 20.

64. Vermeer SE, Algra A, Franke CL, et al. Longterm prognosis after recovery from primary intracerebral hemorrhage. Neurology. 2002 Jul 23;59(2):205-9.

65. Hanger HC, Wilkinson TJ, Fayez-Iskander N, Sainsbury R. The risk of recurrent stroke after intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):836-40. Epub 2007 Jan 12.

66. Hill MD, Silver FL, Austin PC, et al. Rate of stroke recurrence in patients with primary intracerebral hemorrhage. Stroke. 2000 Jan;31(1):123-7.

67. Passero S, Burgalassi L, D’Andrea P, et al. Recurrence of bleeding in patients with primary intracerebral hemorrhage. Stroke. 1995; 26: 1189–92

68. Yen C.C., Lo Y.K., Li J.Y. et al. Recurrent primary intracerebral hemorrhage: a hospital based study. Acta Neurologica. Taiwanica 2007; 16: 74–80

69. Hanger H.C, Wilkinson T.J., Fayez-Iskander N., Sainsbury R. The risk of recurrent stroke after intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):836-40. Epub 2007 Jan 12.

70. Weimar C, Benemann J, Terborg C, et al. Recurrent stroke after lobar and deep intracerebral hemorrhage: a hospital-based cohort study. Cerebrovasc Dis. 2011;32(3):283-8. doi: 10.1159/000330643. Epub 2011 Aug 31.

71. Izumihara A, Suzuki M, Ishihara T. Recurrence and extension of lobar hemorrhage related to cerebral amyloid angiopathy: multivariate analysis of clinical risk factors. Surg Neurol. 2005 Aug;64(2):160-4; discussion 164.

72. 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.

73. Qureshi AI, Tuhrim S, Broderick JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001 May 10;344(19):1450-60.

74. Eckman MH, Rosand J, Knudsen KA, et al. Can patients be anticoagulated after intracerebral hemorrhage? A decision analysis. Stroke. 2003 Jul;34(7):1710-6. Epub 2003 Jun 12.

75. Huhtakangas J, Lö ppö nen P, Tetri S, et al. Predictors for recurrent primary intracerebral hemorrhage: a retrospective population-based study. Stroke. 2013 Mar;44(3):585-90. doi: 10.1161/STROKEAHA.112.671230. Epub 2013 Jan 17.

76. Arima H, Anderson C, Omae T, et al. Effects of blood pressure lowering on intracranial and extracranial bleeding in patients on antithrombotic therapy: the PROGRESS trial. Stroke. 2012 Jun;43(6):1675-7. doi: 10.1161/STROKEAHA.112.651448. Epub 2012 Apr 24.

77. Biffi A, Halpin A, Towfighi A, et al. Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology. 2010 Aug 24;75(8):693-8. doi: 10.1212/WNL. 0b013e3181eee40f.

78. O’Donnell HC, Rosand J, Knudsen KA, et al. Apolipoprotein E genotype and the risk of recurrent lobar intracerebral hemorrhage. N Engl J Med. 2000 Jan 27;342(4):240-5.

79. Tzourio C, Arima H, Harrap S, et al. APOE genotype, ethnicity, and the risk of cerebral hemorrhage. Neurology. 2008 Apr 15;70 (16):1322-8. doi: 10.1212/01.wnl.0000308819. 43401.87. Epub 2008 Feb 6.

80. Брюхов ВВ, Максимова МЮ, Коновалов РН, Кротенкова МВ. Приоритеты визуализации внутримозговых гематом (обзор литературы). Медицинская визуализация. 2007;(6):9-17. [Bryukhov VV, Maksimova MYu, Konovalov RN, Krotenkova MV. Priorities visualization of intracerebral hematomas (literature review). Meditsinskaya vizualizatsiya. 2007;(6):9-17. (In Russ.)].

81. Greenberg SM, Eng JA, Ning M, et al. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. Stroke. 2004 Jun;35(6):1415-20. Epub 2004 Apr 8.

82. Lovelock CE, Cordonnier C, Naka H, et al. Antithrombotic drug use, cerebral microbleeds, and intracerebral hemorrhage: a systematic review of published and unpublished studies. Stroke. 2010 Jun;41(6):1222-8. doi: 10.1161/ STROKEAHA.109.572594. Epub 2010 Apr 29.

83. Azarpazhooh MR, Nicol MB, Donnan GA, at al. Patterns of stroke recurrence according to subtype of first stroke event: the North East Melbourne Stroke Incidence Study (NEMESIS). Int J Stroke. 2008 Aug;3(3):158-64. doi: 10.1111/j.1747-4949.2008.00204.x.

84. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010 Nov;138(5):1093-100. doi: 10.1378/chest.10-0134. Epub 2010 Mar 18.

85. Apostolakis S, Lane DA, Guo Y, et al. Performance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation). J Am Coll Cardiol. 2012 Aug 28;60(9):861-7. doi: 10.1016/j.jacc.2012.06.019. Epub 2012 Aug 1.

86. Lane DA, Lip GY. Use of the CHA2DS2-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012 Aug 14;126(7):860-5. doi: 10.1161/CIRCULATIONAHA. 111.060061.

87. Zia E, Engstrom G, Svensson PJ, et al. Three-year survival and stroke recurrence rates in patients with primary intracerebral hemorrhage. Stroke. 2009 Nov;40(11):3567-73. doi: 10.1161/STROKEAHA.109.556324. Epub 2009 Sep 3.

88. Yokota C, Minematsu K, Hasegawa Y, et al. Long-term prognosis, by stroke subtypes, after a first-ever stroke: a hospital-based study over a 20-year period. Cerebrovasc Dis. 2004;18(2):111-6. Epub 2004 Jun 22.

89. Lerario MP, Gialdini G, Lapidus DM, et al. Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation. PLoS One. 2015 Dec 23;10(12):e0145579. doi: 10.1371/journal.pone.0145579. eCollection 2015.

90. Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010 Dec;41(12):2731-8. doi: 10.1161/STROKEAHA.110.590257. Epub 2010 Oct 21.

91. Ntaois G, Lip GY, Makaritsis K, et al. CHADS2, CHA2DS2-VASc, and long-term stroke outcome in patients without atrial fibrillation. Neurology. 2013 Mar 12;80(11):1009-17. doi: 10.1212/WNL.0b013e318287281b. Epub 2013 Feb 13.

92. Lee RJ, Bartzokis T, Yeoh TK, et al. Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography. Stroke. 1991 Jun;22(6):734-9.

93. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb;137(2):263-72. doi: 10.1378/chest.09-1584. Epub 2009 Sep 17.

94. Gallego P, Roldаn V, Torregrosa JM, et al. Relation of the HAS-BLED bleeding risk score to major bleeding, cardiovascular events, and mortality in anticoagulated patients with atrial fibrillation. Circ Arrhythm Electrophysiol. 2012 Apr;5(2):312-8. doi: 10.1161/CIRCEP. 111.967000. Epub 2012 Feb 7.

95. Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007 Oct 16;116(16):e391-413.

96. Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial.

97. Circulation. 2011 May 31;123(21):2363-72. doi: 10.1161/CIRCULATIONAHA.110.004747. Epub 2011 May 16.

98. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association. Europace. 2012 Oct;14(10):1385-413. Epub 2012 Aug 24.

99. Horstmann S, Zugck C, Krumsdorf U, et al. Left atrial appendage occlusion in atrial fibrillation after intracranial hemorrhage. Neurology. 2014 Jan 14;82(2):135-8. doi: 10.1212/WNL. 0000000000000022. Epub 2013 Dec 6.

100. Reddy VY, Doshi SK, Sievert H, et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) Trial. Circulation. 2013 Feb 12;127(6):720-9. doi: 10.1161/CIRCULATIONAHA. 112.114389. Epub 2013 Jan 16.

For citation:

Domashenko M.A. Hemorrhagic stroke and oral anticoagulants: What is to be done? Neurology, Neuropsychiatry, Psychosomatics. 2016;8(1):61-70. (In Russ.)

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