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Restarting anticoagulation after hemorrhagic stroke

Joji B. Kuramatsu, MD, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany, comments on open questions surrounding the reinitiation of oral anticoagulation in patients with ischemic or hemorrhagic stroke. In particular, anticoagulant-associated intracranial hemorrhage is associated with high morbidity and mortality and there is very little evidence to guide the restart of anticoagulation in survivors. Observational data suggest there is a significant reduction in ischemic events when anticoagulation is restarted after a bleeding event, but this must be balanced against the substantial risk of hematoma expansion or new hemorrhagic lesions. Several randomized trials are investigating the risk-benefit ratio in this setting. This interview took place at European Stroke Organisation Conference 2022 in Lyon, France.