Real-world timing of early anticoagulation therapy in intracerebral hemorrhage patients with atrial fibrillation: An observational study

BACKGROUND: The efficacy of anticoagulation therapy in patients with intracerebral hemorrhage (ICH) and concomitant atrial fibrillation (AF) remains controversial. As the decision to resume anticoagulation therapy remains debated, the optimal timing for resumption has rarely been investigated. This study retrospectively explored the timing of anticoagulation initiation using data from a multicenter registry of eight stroke centers. METHODS: Clinical data of patients with ICH and AF, including the timing of anticoagulant initiation, baseline laboratory findings, prior antithrombotic use, treatment for ICH, and imaging findings (hematoma location, volume, expansion, and cerebral microbleeds), were retrospectively collected. Outcomes included the modified Rankin Scale (mRS) scores at discharge and after 3 months and a 1-year composite outcome of all-cause death, thromboembolic events, and hemorrhagic events. RESULTS: Among 2066 patients with ICH, 242 (11.7%) had AF. The median time to anticoagulation therapy initiation was 7 days (IQR, 3-14 days). Patients were classified into the early (≤7 days, n = 71), late (>7 days, n = 64), and no resumption (n = 107) groups. The early group showed significantly better mRS scores at discharge and 3 months (p < 0.0001). The composite outcome was more common in the no resumption group. Compared with no resumption, resumption (early or late) was associated with lower 1-year composite outcomes, whereas early versus late resumption showed no significant difference, although resumption was associated with an increase in hemorrhagic events (p = 0.028). CONCLUSIONS: The timing of anticoagulation therapy resumption was not significantly associated with 1-year outcomes. Early resumption may be safe, although long-term bleeding risk warrants caution.