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Restarting Anticoagulant Therapy after Intracranial Hemorrhage A Systematic Review and Meta-Analysis
- Publication Year :
- 2017
-
Abstract
- Background and Purpose— The safety and efficacy of restarting anticoagulation therapy after intracranial hemorrhage (ICH) remain unclear. We performed a systematic review and meta-analysis to summarize the associations of anticoagulation resumption with the subsequent risk of ICH recurrence and thromboembolism. Methods— We searched published medical literature to identify cohort studies involving adults with anticoagulation-associated ICH. Our predictor variable was resumption of anticoagulation. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects models to assess the strength of association between anticoagulation resumption and our outcomes. Results— Eight studies were eligible for inclusion in the meta-analysis, with 5306 ICH patients. Almost all studies evaluated anticoagulation with vitamin K antagonists. Reinitiation of anticoagulation was associated with a significantly lower risk of thromboembolic complications (pooled relative risk, 0.34; 95% confidence interval, 0.25–0.45; Q =5.12, P for heterogeneity=0.28). There was no evidence of increased risk of recurrent ICH after reinstatement of anticoagulation therapy, although there was significant heterogeneity among included studies (pooled relative risk, 1.01; 95% confidence interval, 0.58–1.77; Q =24.68, P for heterogeneity Conclusions— In observational studies, reinstitution of anticoagulation after ICH was associated with a lower risk of thromboembolic complications and a similar risk of ICH recurrence. Randomized clinical trials are needed to determine the true risk–benefit profile of anticoagulation resumption after ICH.
- Subjects :
- Advanced and Specialized Nursing
medicine.medical_specialty
business.industry
Publication bias
030204 cardiovascular system & hematology
Lower risk
medicine.disease
Article
law.invention
03 medical and health sciences
Study heterogeneity
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
Anesthesia
Relative risk
Meta-analysis
medicine
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Stroke
030217 neurology & neurosurgery
Cohort study
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....e8a3046373402d3bf438f2cc83d098ea