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There is no evidence from randomised clinical trials with regard to the question if and when to resume antithrombotic medication in patients who have suffered an intracerebral haemorrhage and in whom medication continues to be indicated. It is unknown whether new oral anticoagulants are more suitable than vitamin K antagonists in this group of patients. Oral anticoagulants should probably not be resumed in patients with a lobar intracerebral haemorrhage caused by cerebral amyloid angiopathy. They can be considered in patients with a haemorrhage in subcortical regions of the brain, the brain stem or the cerebellum, provided that blood pressure levels are under control. Depending on the risk of a cardiac embolus, antithrombotic medication can be resumed from 1 to 10 weeks after the intracerebral haemorrhage. In patients with atrial fibrillation this risk can be calculated using the CHA2DS2-VASc score. In patients with a cardiac indication for antithrombotic medication the decision whether or not to resume medication should be made by a cardiologist and a neurologist in collaboration.

Thus far no effective treatment for an intracerebral haemorrhage has been available. A randomized clinical trial recently showed that treatment of hypertension in the acute phase of spontaneous intracerebral haemorrhage with a target systolic blood pressure of 140 mmHg is safe and improves prognosis. The effect of blood pressure reducing therapy was small and not statistically significant for the primary outcome (mortality or severe morbidity). Moreover, this effect was shown in one trial only. Therefore the clinical relevance of these study results remains debatable. Considering all available arguments, in patients with a systolic blood pressure150 mmHg in the first 6 hours after spontaneous intracerebral haemorrhage the Dutch Neurovascular Working Group recommends lowering the blood pressure to a target systolic level of 140 mmHg within 1 hour and maintaining this target level for 1 week. When this strategy is not chosen, we recommend that a systolic blood pressure180 mmHg should be treated anyway, with a target level of 160 mmHg.