Background and
Purpose—This study aims to provide observational data on the
relationship between the timing of antithrombotic treatment and the
competing risks of severe thrombotic and hemorrhagic events in a
cohort of Swedish patients with atrial fibrillation and intracerebral
hemorrhage (ICH).
Methods—Patients
with atrial fibrillation and a first-ever ICH were identified in the
Swedish Stroke Register, Riksstroke, 2005 to 2012. Riksstroke was
linked with other national registers to find information on
treatment, comorbidity, and outcome. The optimal timing of treatment
in patients with low and high thromboembolic risk was described
through cumulative incidence functions separately for thrombotic and
hemorrhagic events and for the combined end point vascular death or
nonfatal stroke.
Results—The study
included 2619 ICH survivors with atrial fibrillation with 5759
person-years of follow-up. Anticoagulant treatment was associated
with a reduced risk of vascular death and nonfatal stroke in
high-risk patients with no significantly increased risk of severe
hemorrhage. The benefit seemed to be greatest when treatment was
started 7 to 8 weeks after ICH. For high-risk women, the total risk
of vascular death or stroke recurrence within 3 years was 17.0% when
anticoagulant treatment was initiated 8 weeks after ICH and 28.6%
without any antithrombotic treatment (95% confidence interval for
difference, 1.4%–21.8%). For high-risk men, the corresponding risks
were 14.3% versus 23.6% (95% confidence interval for difference,
0.4%–18.2%).
Conclusions—This
nationwide observational study suggests that anticoagulant treatment
may be initiated 7 to 8 weeks after ICH in patients with atrial
fibrillation to optimize the benefit from treatment and minimize
risk.
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