Antithrombotic Therapy After Intracerebral Hemorrhage

Study Questions:

What is the prevalence of indication for antithrombotic therapy (AT) among patients hospitalized with first-time intracerebral hemorrhage (ICH) and the impact of subsequent AT use on the long-term clinical outcome?


The investigators performed a population-based cohort study using nationwide Danish medical registries. Patients with risk of thromboembolism surviving the first 30 days after hospitalization because of ICH were identified and followed up. The authors estimated the hazard ratio of all-cause death, thromboembolic events, or major bleeding according to use of AT.


The investigators identified 6,369 patients between 2005 and 2013. Among these patients, 2,978 (47%) had an indication for AT, and during the follow-up, (median: 2.3 years), 1,281 (43%) died, 497 (17%) had a thromboembolic event, and 536 (18%) had major bleeding. Postdischarge use of oral anticoagulation therapy (OAT) among patients with an indication for OAT was associated with a significantly lower risk of death (adjusted hazard ratio [AHR], 0.59; 95% confidence interval [CI], 0.43–0.82) and thromboembolic events (AHR, 0.58; 95% CI, 0.35–0.97) and no increased risk of major bleeding (AHR, 0.65; 95% CI, 0.41–1.02). In contrast, use of platelet inhibitors among patients with an indication for platelet inhibitors was not related to statistically significantly improved clinical outcome.


The authors concluded that postdischarge use of OAT was associated with a lower risk of all-cause mortality and thromboembolic events and no increased risk of major bleeding among patients surviving ICH.


This study reports that almost half of the patients surviving the first 30 days after their ICH event had an indication for AT in a nationwide observational study. Overall, the use of AT post-ICH, in particular OAT, was associated with a lower risk of death and thromboembolic events and no increased risk of major bleeding, including recurrent ICH, although not reaching statistical significance in all analyses. It is important to understand that all of the data presented to date are observational, and should not be interpreted as a recommendation for unselected and aggressive use of OAT in all patients with a high predicted risk of thromboembolism surviving ICH. The decision of whether to use or avoid OAT should in any case depend on a thorough assessment of the individual patient’s thrombohemorrhagic risk and should reflect the patient’s preferences and informed choice.

Clinical Topics: Anticoagulation Management, Prevention

Keywords: Anticoagulants, Cerebral Hemorrhage, Fibrinolytic Agents, Hemorrhage, Mortality, Platelet Aggregation Inhibitors, Primary Prevention, Stroke, Thromboembolism, Treatment Outcome, Vascular Diseases

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