Use of Anticoagulants, History of ICH Offset by Recurrent ICH Risk

Background: Oral anticoagulation (OAC) reduces the risk of ischemic stroke in patients with atrial fibrillation (AF) but considerably raises the risk of intracranial hemorrhage (ICH) in those with a history of the same. Randomized controlled trials (RCTs) of this issue have not settled whether the benefit outweighs the risk, partly because of the small number of participants. Objective: To update the evidence on the efficacy and safety of OAC in patients with AF with a history of ICH. Design: Systematic review and meta-analysis. Methods: Studies with high-quality RCTs of OAC for AF in patients with a prior history of ICH were included. The heterogeneity and risk of bias of the RCTs were assessed with Cochrane review tools. The 2 primary outcomes were the first incident ischemic stroke and the first incident recurrent ICH. Secondary outcomes included any major hemorrhage and a composite “net clinical benefit,” which consisted of the 2 primary outcomes. Meta-analysis was pe more...