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BMJ Open. 2018 May 14;8(5):e019672. doi: 10.1136/bmjopen-2017-019672.

Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis.

Zhou Z#1,2, Yu J#2,3, Carcel C2,4,5, Delcourt C2,4,5, Shan J6, Lindley RI2,5, Neal B2,7,8, Anderson CS2,4,9, Hackett ML2,5.

Author information

1
Department of Radiology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
2
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
3
Department of Cardiology, Peking University Third Hospital, Beijing, China.
4
Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia.
5
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
6
Department of Geriatrics, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
7
The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
8
Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
9
The George Institute China, Peking University Health Science Center, Beijing, China.
#
Contributed equally

Abstract

OBJECTIVE:

To determine the adverse outcomes following resumption of anticoagulation in patients with anticoagulation-associated intracranial haemorrhage (ICH).

DESIGN:

We performed a systematic review and meta-analysis in this clinical population. The Preferred Reporting Items for Systemic Reviews and Meta-Analyses statement was followed, and two authors independently assessed eligibility of all retrieved studies and extracted data.

DATA SOURCES:

Medline, Embase and the Cochrane Central Register of Controlled Trials, from inception to February 2017.

ELIGIBILITY CRITERIA AND OUTCOMES:

Randomised controlled trials or cohort studies that recruited adults who received oral anticoagulants at the time of ICH occurrence and survived after the acute phase or hospitalisation were searched. Primary outcomes, including long-term mortality, recurrent ICH and thromboembolic events. Secondary outcomes were the frequency of resuming anticoagulant therapy and related factors.

RESULTS:

We included 12 cohort studies (no clinical trials) involving 3431 ICH participants. The pooled frequency of resuming anticoagulant therapy was 38% (95% CI 32% to 44%), but this was higher in participants with prosthetic heart valves, subarachnoid haemorrhage or dyslipidaemia. There was no evidence that resuming anticoagulant therapy was associated with higher long-term mortality (pooled relative risk (RR) 0.60, 95% CI 0.30 to 1.19; p=0.14) or ICH recurrence (pooled RR 1.14, 95% CI 0.72 to 1.80; p=0.57). Resumption of anticoagulation was associated with significantly fewer thromboembolic events (pooled RR 0.31, 95% CI 0.23 to 0.42; p<0.001). In a subgroup of patients with atrial fibrillation, resuming anticoagulant therapy was associated with fewer long-term mortality (pooled RR 0.27, 95% CI 0.20 to 0.37, p<0.001).

CONCLUSIONS:

Based on these observational studies, resuming anticoagulant therapy after anticoagulation-associated ICH has beneficial effects on long-term complications. Clinical trials are needed to substantiate these findings.

PROSPERO REGISTRATION NUMBER:

CRD42017063827.

KEYWORDS:

anticoagulation; anticoagulation-associated Intracranial hemorrhage; meta-analysis; mortality; thromboembolic events

PMID:
29764874
PMCID:
PMC5961574
DOI:
10.1136/bmjopen-2017-019672
[Indexed for MEDLINE]
Free PMC Article

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