Should AF Be Anticoagulated After an ICH?

Background: Anticoagulation dramatically benefits stroke prevention among patients with atrial fibrillation (AF), yet anticoagulation may precipitate severe bleeding, most ominously intracranial hemorrhage (ICH). Therefore, patients who have previously suffered ICH may need to balance the potential benefits of anticoagulation versus the possible recurrence of ICH, which may be disabling or even fatal in effect. Objective: To provide the most comprehensive evaluation to date of anticoagulation versus no anticoagulation in patients with atrial fibrillation and prior intracranial hemorrhage. Design: Systematic review and meta-analysis. Methods: 3 large medical databases were searched from inception through May 2025 for studies reporting results of anticoagulation versus no anticoagulation among patients with previous ischemic stroke. Eventually, 5 randomized controlled trials involving 733 patients, nearly evenly categorized between groups, were included. Results: Anticoagulation was as more...