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Effectiveness and safety of antithrombotic medication in patients with atrial fibrillation and intracranial haemorrhage: systematic review and meta-analysis

Ivany, E, Ritchie, L, Lip, GYH, Lotto, R, Werring, D and Lane, DA (2022) Effectiveness and safety of antithrombotic medication in patients with atrial fibrillation and intracranial haemorrhage: systematic review and meta-analysis. Stroke, 53 (10). pp. 3035-3046. ISSN 0039-2499

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Background For patients with atrial fibrillation (AF) who survive an intracranial haemorrhage (ICrH), the decision to offer OAC is challenging and necessitates balancing risk of thromboembolic events with risk of recurrent ICrH.
Methods This systematic review assesses the effectiveness and safety of OAC and/or antiplatelets in patients with AF with non-traumatic ICrH. Bibliographic databases CENTRAL, MEDLINE, EMBASE and CINAHL were searched. Articles on adults with AF with spontaneous ICrH (intracerebral, subdural, subarachnoid), receiving antithrombotic therapy for stroke prevention were eligible for inclusion.
Results Twenty papers (50,470 participants) included: two RCTs (n=304); eight observational studies, eight cohort studies, and two studies that meta-analysed individual-level data from observational studies. OAC therapy was associated with a significant reduction in thromboembolic events (summary relative risk (sRR) 0.51, 95% confidence interval (CI) 0.30-0.86, heterogeneity I2=2%, p=0.39, n=5 studies) and all-cause mortality (sRR 0.52, 95% CI 0.38-0.71, heterogeneity I2=0, p=0.44, n=3 studies). OAC therapy was not associated with an increased risk of recurrent ICrH (sRR 1.44, 95% CI 0.38-5.46, heterogeneity I2=70%, p=0.02, n=5 studies). Non-vitamin K antagonist oral anticoagulants (NOAC) were more effective at reducing the risk of thromboembolic events (sRR 0.65, 95% CI 0.44-0.97, heterogeneity I2=72%, p=0.03, n=3 studies) and were associated with a lower risk of recurrent ICrH (sRR 0.52, 95% CI 0.40-0.67, heterogeneity I2=0%, p=0.43, n=3 studies) than warfarin.
Conclusion In non-traumatic ICrH survivors with AF, OAC therapy is associated with a reduced risk of thromboembolic events and all-cause mortality without significantly increasing risk of recurrent ICrH. This finding is primarily based on observational data and further larger RCTs are needed to corroborate or refute these findings.

Item Type: Article
Uncontrolled Keywords: 1102 Cardiorespiratory Medicine and Haematology; 1103 Clinical Sciences; 1109 Neurosciences; Neurology & Neurosurgery
Subjects: R Medicine > RT Nursing
Divisions: Nursing & Allied Health
Publisher: Lippincott, Williams & Wilkins
SWORD Depositor: A Symplectic
Date Deposited: 30 May 2022 11:37
Last Modified: 10 Mar 2023 10:30
DOI or ID number: 10.1161/STROKEAHA.122.038752
URI: https://researchonline.ljmu.ac.uk/id/eprint/16970
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