Restarting Anticoagulation 1 Month After Traumatic Intracranial Hemorrhage Reasonable

A 1-month anticoagulation holiday may be sufficient after traumatic intracranial hemorrhage in patients with nonvalvular atrial fibrillation, according to a study published in World Neurosurgery: X.

“The optimal time to restart direct oral anticoagulants for nonvalvular atrial fibrillation after traumatic intracranial hemorrhage is unknown. Physicians must weigh the risk of recurrent hemorrhage against ischemic stroke,” researchers from the departments of neurosurgery and neurology at University of Pennsylvania explained in the study background. “We investigated rates of stroke while holding anticoagulation, hemorrhage after anticoagulation resumption, and factors associated with the decision to restart anticoagulation.”

The case series included 28 patients who experienced traumatic intracranial hemorrhage, mostly from falls, while taking a direct oral anticoagulant and required treatment at a level 1 trauma center. The predominant bleeding pattern was subdural hematoma.

Twenty-five of the patients survived. Among them, 16 patients restarted their direct oral anticoagulant a median 29.5 days after the event. After restarting anticoagulation, 1 patient experienced a rebleed, according to the study.

Just one patient had an embolic stroke, which occurred after being off anticoagulation medicine for 118 days. The resulting incidence rate, researchers reported, was 1 stroke per 7.8 person-years.

“Based on our data and available literature, it may be reasonable to hold anticoagulation for 1 month after index traumatic intracranial hemorrhage after confirming hemorrhage stability,” the authors advised. “Ongoing randomized control trials of traumatic intracranial hemorrhage in the setting of direct oral anticoagulants use will help establish the optimal evidence-based restart time.”

Reference:
Ghenbot Y, Arena JD, Howard S, Wathen C, Kumar MA, Schuster JM. Anticoagulation holiday: resumption of direct oral anticoagulants for atrial fibrillation in patients with index traumatic intracranial hemorrhage. World Neurosurg X. 2022;17:100148. doi:10.1016/j.wnsx.2022.100148