SynthesisStroke2017
Restarting Anticoagulant Therapy After Intracranial Hemorrhage: A Systematic Review and Meta-Analysis.
Abstract readMeta-AnalysisSystematic Review
In one paragraph
Synthesis in Stroke, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 8 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
87citing papers in PubMed, 8 pooled it
–field-weighted citation impact
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
87 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Anticoagulation versus no anticoagulation after intracranial hemorrhage in patients with atrial fibrillation: an updated systematic review and meta-analysis.BMC cardiovascular disorders · 2025Pooled it
- 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2024Guideline
- Guideline
- Systematic review on traumatic intracranial haemorrhage in patients on anti-thrombotic medications; haemorrhage progression, thrombosis, and anti-thrombotic recommencement.Neurosurgical review · 2023Pooled it
- Pooled it
- Meta-Analysis of Oral Anticoagulants and Adverse Outcomes in Atrial Fibrillation Patients After Intracranial Hemorrhage.Frontiers in cardiovascular medicine · 2022Pooled it
- Effects of Prior Antiplatelet Therapy on Mortality, Functional Outcome, and Hematoma Expansion in Intracerebral Hemorrhage: An Updated Systematic Review and Meta-Analysis of Cohort Studies.Frontiers in neurology · 2021Pooled it
- Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis.BMJ open · 2018Pooled it
- Hospital Course and Outcomes After Major Bleeding in Patients on Factor Xa Inhibitors in Japan: A Nationwide Observational Study.Journal of atherosclerosis and thrombosis · 2026Observational
- Managing bleeds on anticoagulant therapy: a practical guide for clinicians.European heart journal. Acute cardiovascular care · 2026Review
- Antithrombotic Therapy After Intracerebral Hemorrhage: Real-World Evidence for In-Hospital Resumption.CNS neuroscience & therapeutics · 2026Article
- Between thrombosis and bleeding: the clinical dilemma of anticoagulation after intracranial hemorrhage.Annals of medicine and surgery (2012) · 2026Article
- Temporary Discontinuation and Restarting of Oral Anticoagulants for Neurological and Cardiac Indications.Deutsches Arzteblatt international · 2026Review
- An Overview of Anticoagulant Drugs Pharmacology, Therapeutic Approaches, Limitations and Perspectives.Pharmaceutics · 2026Review
- Early pharmacologic venous thromboembolism prophylaxis and in-hospital mortality in ICU patients with intracerebral hemorrhage: a landmark, propensity-weighted cohort study.Frontiers in neurology · 2026Article
- Recommencement of anti-thrombotics following traumatic intracranial haemorrhage; a preliminary survey of UK consultant neurosurgeons informing the RESTART-tICrH trial design.Brain & spine · 2026Article
- Umbrella review of anticoagulation strategies for secondary prevention of cardioembolic stroke in atrial fibrillation: efficacy, safety, and knowledge gaps.Annals of medicine and surgery (2012) · 2025Review
- Clinical Characteristics in Adult Congenital Heart Disease Patients With Acute Stroke - A Retrospective Analysis.Circulation reports · 2025Article
- Management of Phlegmasia Cerulea Dolens Alongside Neurologic Contraindication to Anticoagulation: A Therapeutic and Diagnostic Dilemma.Clinical case reports · 2025Article
- Optimizing care for patients after major anticoagulant-related bleeding: a narrative review and proposal for a clinical care pathway.Research and practice in thrombosis and haemostasis · 2025Review
27 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
Authors and funding
10 authors.
Santosh B MurthyFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.). sam9200@med.cornell.edu.
Ajay GuptaFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Alexander E MerklerFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Babak B NaviFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Pitchaiah MandavaFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Costantino IadecolaFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Kevin N ShethFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Daniel F HanleyFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Wendy C ZiaiFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Hooman KamelFrom the Department of Neurology (S.B.M., A.E.M., B.B.N., C.I., H.K.), Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (S.B.M., A.G., A.E.M., B.B.N., C.I., H.K.), and Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY; Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX (P.M.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); Division of Brain Injury Outcomes (D.F.H.), and Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (W.C.Z.).
Funding
Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9MClinical and Translational Science CenterUL1TR000457 · NCATS · WEILL MEDICAL COLL OF CORNELL UNIV · PI IMPERATO-MCGINLEY, JULIANNE L · 2012 to 2016
$46.0MClot Lysis: Evaluating Accelerated Resolution of IVH Phase III (CLEAR III)U01NS062851 · NINDS · JOHNS HOPKINS UNIVERSITY · PI HANLEY, DANIEL F · 2009 to 2013
$21.6MOverexpression of the amyloid precursor protein and cerebrovascular regulationR01NS037853 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI Costantino Iadecola · 1998 to 2026
$10.6MNO SYNTHASE GENE EXPRESSION AND CEREBRAL ISCHEMIC DAMAGER01NS034179 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI IADECOLA, COSTANTINO · 1995 to 2021
$5.5MHypertension and neurovascular dysfunctionR37NS089323 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI IADECOLA, COSTANTINO · 2015 to 2021
$3.1MClinical and Translational Science CenterKL2TR000458 · NCATS · WEILL MEDICAL COLL OF CORNELL UNIV · PI IMPERATO-MCGINLEY, JULIANNE L · 2012 to 2016
$2.1MCHRONIC INTERMITTENT HYPOXIA, NEUROVASCULAR DYSFUNCTION AND STROKER01NS073666 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI IADECOLA, COSTANTINO · 2011 to 2015
$1.8MLeft Atrial abNormality, ThromboEmbolism, and Race: Novel risk factors for stroke (LANTERN)R01NS097443 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI KAMEL, HOOMAN · 2016 to 2019
$1.5MCancer And Risk Of Ischemic StrokeK23NS091395 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI NAVI, BABAK BENJAMIN · 2015 to 2019
$945kAtrial Fibrillation Precursors May Be Novel Stroke Risk FactorsK23NS082367 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI KAMEL, HOOMAN · 2013 to 2017
$937kNCATS NIH HHS KL2 TR000458NCATS NIH HHS UL1 TR000457NCATS NIH HHS UL1 TR001863NINDS NIH HHS K23 NS082367NINDS NIH HHS K23 NS091395NINDS NIH HHS R01 NS034179NINDS NIH HHS R01 NS037853NINDS NIH HHS R01 NS073666NINDS NIH HHS R01 NS097443NINDS NIH HHS R37 NS089323NINDS NIH HHS U01 NS062851
Abstract
background and purposeThe 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.
methodsWe 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.
resultsEight 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;
conclusionsIn 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.
Indexed as
AnticoagulantsHumansIntracranial HemorrhagesMyocardial InfarctionStrokeAnticoagulantsanticoagulationatrial fibrillationmyocardial infarctionstrokethromboembolism
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