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Use of Anticoagulation After Cerebral Hemorrhage.
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Recommendations
For patients who develop an ICH, SAH, or subdural hematoma, all anticoagulants and antiplatelets should be discontinued during the acute period for at least 1 to 2 weeks after the hemorrhage, and the anticoagulant effect should be reversed immediately with appropriate agents (ie, vitamin K, fresh frozen plasma) (Class III, Level of Evidence B).
For patients who require anticoagulation soon after a cerebral hemorrhage, intravenous heparin may be safer than oral anticoagulation. Oral anticoagulants may be resumed after 3 to 4 weeks, with rigorous monitoring and maintenance of INRs in the lower end of the therapeutic range (Class IIb, Level of Evidence C).
Special circumstances: anticoagulation should not be resumed after an SAH until the ruptured aneurysm is definitively secured (Class III, Level of Evidence C). Patients with lobar ICHs or microbleeds and suspected cerebral amyloid angiopathy on MRI may be at a higher risk for recurrent ICH if anticoagulation needs to be resumed (Class IIb, Level of Evidence C). For patients with hemorrhagic infarction, anticoagulation may be continued, depending on the specific clinical scenario and underlying indication for anticoagulant therapy (Class IIb, Level of Evidence C) (Table 7 Up).
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