ArticleJACC. Asia2025
Outcomes of Reinitiating Direct Oral Anticoagulants After Intracranial Hemorrhage: A Sequential Target Trial Emulation Study.
Article in JACC. Asia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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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.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline 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
- Balancing Risks and Timing: Reinitiating DOACs After Intracranial Hemorrhage in Atrial Fibrillation Patients.JACC. Asia · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhether or not to reinitiate direct oral anticoagulants (DOACs) in atrial fibrillation patients who survived an antithrombotic agent-associated intracranial hemorrhage (ICH) event remains inconclusive.
objectivesThe primary purpose of this study was to investigate the effectiveness and safety of DOACs after ICH, with the secondary objective to explore the optimal timing of DOAC reinitiation.
methodsA sequential target trial emulation study was conducted using the National Health Insurance claims data in Taiwan. We included AF patients receiving antithrombotic therapy who later developed an ICH event between June 2012 and December 2018. Post-ICH DOAC reinitiation status was assessed at 6 consecutive 14-day intervals after discharge. We further stratified our analysis using the stroke severity index to explore the optimal timing of DOAC reinitiation. Study outcomes were all-cause mortality, ICH, and ischemic stroke. Adjusted HRs (aHRs) were estimated using Cox proportional hazards models.
resultsDOAC reinitiation was associated with lower risks of all-cause mortality (aHR: 0.73; 95% CI: 0.61-0.88) without increased ICH risk (aHR: 1.21; 95% CI: 0.81-1.80) compared with no antithrombotic therapy after ICH. The ischemic stroke risk after reinitiating DOAC was similar to that with no antithrombotic therapy (aHR: 0.73; 95% CI: 0.47-1.14). Reinitiating DOACs within 14 and 28 days after discharge most benefited patients with low and high ICH severity, respectively.
conclusionsDOAC is associated with lower risk of all-cause mortality. The optimal timing of DOAC reinitiation varies by ICH severity, with later reinitiation recommended for patients with higher ICH severity.
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