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NOACs and intracranial bleeds

Dr Malik sees that NOACs can be used (with care) in patients with Intracranial Haemorrhage (ICH).
If you have had an intracranial bleed, but need anti-coagulation because of stroke risk from Atrial Fibrillation (AF), then what to do next is a challenge.
1. Left Atrial Appendage (LAA) closure
2. Restart Warfarin
3. Novel Direct Oral Anticoagulant (NOAC or DOAC).
This study was a combination of three previous studies: multicenter study on ICH and oral anticoagulation therapy conducted in Germany (n = 542), a longitudinal primary ICH study conducted in Boston (n = 268), and the multicenter Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study (n = 217).
About 1/4 were restarted on NOACs:  179 (28%) with nonlobar and 88 (23%) with lobar hemorrhages resumed oral anticoagulation. Interestingly these patients lived longer and functioned better than those that did not restart treatment. However, these patients were selected by the doctors.
It does not mean that NOACs are the ideal treatment for all these patients. LAA occlusion is a very reasonable option.
International Stroke Conference (ISC) 2017. Abstract LB6. Presented February 23, 2017

More info here.

Posted on 01 March 2017
Author: Hafsa Malik
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