Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage: Systematic Review and Meta-Analysis

Ivany, Elena, Ritchie, Leona A ORCID: 0000-0002-0392-1767, Lip, Gregory YH ORCID: 0000-0002-7566-1626, Lotto, Robyn R, Werring, David J and Lane, Deirdre A ORCID: 0000-0002-5604-9378
(2022) Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage: Systematic Review and Meta-Analysis. STROKE, 53 (10). pp. 3035-3046.

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<h4>Background</h4>For patients with atrial fibrillation who survive an intracranial hemorrhage (ICrH), the decision to offer oral anticoagulation (OAC) is challenging and necessitates balancing risk of thromboembolic events with risk of recurrent ICrH.<h4>Methods</h4>This systematic review assesses the effectiveness and safety of OAC and/or antiplatelets in patients with atrial fibrillation with nontraumatic ICrH. Bibliographic databases CENTRAL, MEDLINE, EMBASE, and CINAHL were searched. Articles on adults with atrial fibrillation with spontaneous ICrH (intracerebral, subdural, and subarachnoid), receiving antithrombotic therapy for stroke prevention were eligible for inclusion.<h4>Results</h4>Twenty articles (50 470 participants) included 2 randomized controlled trials (n=304)' 8 observational studies, 8 cohort studies, and 2 studies that meta-analyzed individual-level data from observational studies. OAC therapy was associated with a significant reduction in thromboembolic events (summary relative risk [sRR], 0.51 [95% CI, 0.30-0.86], heterogeneity I<sup>2</sup>=2%; <i>P</i>=0.39, n=5 studies) and all-cause mortality (sRR, 0.52 [95% CI, 0.38-0.71], heterogeneity I<sup>2</sup>=0; <i>P</i>=0.44, n=3 studies). OAC therapy was not associated with an increased risk of recurrent ICrH (sRR, 1.44 [95% CI, 0.38-5.46], heterogeneity I<sup>2</sup>=70%, <i>P</i>=0.02, n=5 studies). Nonvitamin K antagonist OACs were more effective at reducing the risk of thromboembolic events (sRR, 0.65 [95% CI, 0.44-0.97], heterogeneity I<sup>2</sup>=72%, <i>P</i>=0.03, n=3 studies) and were associated with a lower risk of recurrent ICrH (sRR, 0.52 [95% CI, 0.40-0.67], heterogeneity I<sup>2</sup>=0%, <i>P</i>=0.43, n=3 studies) than warfarin.<h4>Conclusions</h4>In nontraumatic ICrH survivors with atrial fibrillation, OAC therapy is associated with a reduced risk of thromboembolic events and all-cause mortality without significantly increasing risk of recurrent ICrH. This finding is primarily based on observational data, and further larger randomized controlled trials are needed to corroborate or refute these findings.

Item Type: Article
Uncontrolled Keywords: anticoagulant, atrial fibrillation, intracranial hemorrhage, ischemic stroke, systematic review
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 26 Oct 2022 10:06
Last Modified: 18 Jan 2023 19:49
DOI: 10.1161/STROKEAHA.122.038752
Open Access URL: https://doi.org/10.1161/STROKEAHA.122.038752
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3165772