{"id":"eba1cd609313","type":"article","url":"https://hartvaat.nl/2023/10/12/anticoagulatie-bij-af-na-eerdere-intracraniele-bloeding-meta-analyse/","title":"Anticoagulatie bij AF na eerdere intracraniële bloeding: meta-analyse","title_en":"Anticoagulant in atrial fibrillation patients with prior intracranial haemorrhage: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["abelacimab","anticoagulantia","anticoagulatie-kwetsbare-ouderen","bloeddrukbehandeling","rivaroxaban"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2023-322492","source_url":"https://doi.org/10.1136/heartjnl-2023-322492","authors":["Huiya Cai","Guoquan Chen","Wei Hu","Chunjiao Jiang"],"significance":7,"published":"2023-10-12","source_date":"2023-10-12","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis showed that resuming anticoagulation (preferably with DOACs) in AF patients after intracranial hemorrhage is associated with fewer ischemic events and lower mortality without a significant increase in recurrent ICH, supporting cautious anticoagulation restart.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat herstart van anticoagulatie bij AF-patiënten na intracraniële bloeding geassocieerd is met minder ischemische CVA's zonder significant meer recidief-bloedingen. Dit ondersteunt voorzichtige herstart bij geselecteerde patiënten.","abstract_original":"BACKGROUND: The benefit of resuming anticoagulation in atrial fibrillation (AF) patients with prior intracranial haemorrhage (ICH) and which anticoagulant to choose are controversial. SUMMARY OF REVIEW: PubMed, Embase, Web of Science and the Cochrane Library were searched from their inception until 13 February 2022. Thirteen eligible articles (17 600 participants) were collected, including 11 real-world studies (n=17 296) and 2 randomised controlled trials (RCTs) (n=304). Compared with no anticoagulants, oral anticoagulation (OAC) was not associated with an increased risk of ICH recurrence (HR 0.85 (95% CI 0.57 to 1.25), p=0.41), but with a significantly increased risk of major bleeding (HR 1.66 (95% CI 1.20 to 2.30), p<0.01). Meanwhile, OAC was associated with a reduced risk of ischaemic stroke/systemic thromboembolism (IS/SE) (HR 0.54 (95% CI 0.42 to 0.70), p<0.01) and all-cause death (HR 0.38 (95% CI 0.28 to 0.52), p<0.01) compared with no anticoagulants. Furthermore, compared with warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were associated with a significant reduction of ICH recurrence (HR 0.64 (95% CI 0.49 to 0.85), p<0.01), while the risk of IS/SE and all-cause mortality were comparable between warfarin and NOACs. CONCLUSIONS: For patients with AF with prior ICH, OAC is associated with a significant reduction in IS/SE and all-cause mortality without increasing ICH recurrence, but may increase major bleeding risk. Compared with warfarin, NOACs had a better safety profile and comparable efficacy. Further larger RCTs are warranted to validate these findings."}