Restarting Anticoagulation After Brain Hemorrhage in AF (2025)
Restarting Anticoagulation After Brain Hemorrhage in AF (2025)
Source: Medscape News UK
Date: December 31, 2025
Journal: Therapeutic Advances in Neurological Disorders (Dec 21, 2025)
Clinical Question
• Should oral anticoagulants be restarted in patients with atrial fibrillation (AF) after intracerebral hemorrhage (ICH)?
What the Study Found
• Restarting anticoagulation:
• ↓ Ischemic stroke by 80%
(NNT = 9)
• ↓ Ischemic MACE by 59%
• But:
• ↑ Recurrent ICH ~3-fold
(NNH = 19)
• ↑ Hemorrhagic MACE
• No difference in:
• All-cause mortality
• Cardiovascular death
Bottom Line
• Restarting anticoagulation prevents strokes
• But increases risk of recurrent brain bleeding
• Overall survival is unchanged
In Practice
• Restarting OAC may provide net benefit in carefully selected patients
• Decision must be individualized, considering:
• ICH type (lobar vs non-lobar)
• Baseline bleeding risk
• Ischemic risk (CHA₂DS₂-VASc)
• Comorbidities
• Patient preferences
Key Message
After ICH, anticoagulation in AF is not “yes or no” — it is a personalized risk–benefit decision.
