ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025
Early anticoagulant resumption after atypical intracerebral hemorrhage: beyond atrial fibrillation analysis of two clinical cases admitted to the University Hospital of Pisa.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe literature extensively addresses the timing of anticoagulant therapy resumption after lobar intracerebral hemorrhage (ICH) in patients with atrial fibrillation (AF). However, there is few data for patients with lobar (atypical) ICH requiring anticoagulation for non-AF indications. CASES DESCRIPTION: We present two cases of non-surgical, medium-sized lobar ICH where anticoagulant therapy was resumed early: the first case involved a hypertensive patient on warfarin and clopidogrel for left ventricular thrombosis following acute myocardial infarction and coronary stenting; the second one a patient with probable cerebral amyloid angiopathy (CAA) on warfarin (INR 3.87 at onset) due to an aortic valve prosthesis. Alternative treatments to anticoagulation were not viable in either case, necessitating early resumption of therapy. During follow-up, no clinical or radiological evidence of rebleeding was observed in either patient.
conclusionsThese cases suggest that early anticoagulation resumption (within 4 weeks) may be safe in the short term, even in patients with a high risk of rebleeding and no alternative options. Evidence-based guidelines are urgently needed, particularly for patients with non-AF conditions.
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