Stroke: Should the brain haemorrhage of combined atrial fibrillation resist coagulation?

Intracranial hemorrhage (ICH) is a devastating disease associated with a 30-day mortality rate (from 25-50%)Patients with ICH also have risk factors for ischemic stroke, including atrial fibrillation (AF), which increases the risk of heart-borne ischemic stroke by five timesAlthough the value of anticoagulant therapy has been established to significantly reduce the incidence of ischemic events, the safety of anticoagulant therapy after ICH to start or restart anticoagulant therapy to prevent thrombosis is still controversialsome authors have found a relatively low risk of recurrent bleeding, including anticoagulant treatment, including ICHFor example, meta analysis suggested that restarting anticoagulant therapy after ICH was associated with a decreased blood clot tinge event rate and did not significantly increase ICH recurrenceAs a result, some researchers have called for a wider use of anticoagulant therapy after ICHHowever, other studies have found a significant increase in the risk of recurrent ICH after anticoagulant treatmentseveral risk assessment tools have been developed and validated to assess the risk of ischemic stroke and haemorrhage in patients with anticoagulant atrialThe most widely used and validated good ratings include the CHA2DS2-VASc score for predicting ischemic events and the HAS-BLED score for anticoagulant riskHowever, some risk factors (age, high blood pressure and past stroke) contribute to both scoring systems, so it is challenging to develop the best plan, especially for patients with atrial fibrillation and ICHhas developed electronic decision support software to help clinicians deal with complex situationsThese tools use the patient's electronic health record information to assess net clinical benefits (NCCs) or net clinical losses associated with individualized treatment decisionsThe Atrial Fibrillation Decision Support Tool, AFDST was developed by one of the authors of this paper to guide decision-making in anticoagulant therapy in AF patientsIn 2003, Eckman et alconducted a decision analysis specifically for the use of warfarin anticoagulant in patients with previous history of atrial fibrillationThe results of this analysis recommend not to resist coagulation, especially in patients with a history of bleeding from the cerebral lobeThe results of patients who have had deep bleeding before are less clearHowever, there have been significant clinical changes since 2003Direct acting anticoagulants (Direct acting anticoagulants, DOAC) is comparable to warfarin, but the risk of bleeding is lowIn addition, the new algorithm has been able to better layer the risk of atrial fibrillation-related stroke and bleeding (CHA2DS2-VASc and HAS-BLED scores)the results of their study, published in March 2020 in Stroke by Robert JStanton of the United States, used data from the GERFHS III study to estimate the net clinical benefits of anticoagulant therapy (vs no treatment) for patients with ICH combined atrial fibrillation95 of the 1,186 patients with spontaneous ICH combined atrial fibrillationWithin one year, 8 (8%) of 95 patients were expected to experience hyperhaemorrhage events with anticoagulant therapy, and 5 (5%) of 95 patients were expected to have an anticoagulant ischemic strokeThe risk of hemorrhage in 68 out of 95 cases (71%) was higher than the risk of ischemic strokeIn 73% of patients, DOAC anticoagulant therapy resulted in no clinically significant benefits or lossesApproximately 12% of patients will receive a quality adjustment of life year (QALY), and 15% of patients will lose .1 QALYMost patients treated with aspirin did not have significant clinical net gains or lossesOverall, anticoagulant therapy throughout the queue will result in a total loss of 0.92 QALYthe final authors believe that our analysis suggests that conventional anticoagulant after ICH will be associated with a net loss of QALYIn patients with ICH-combined atrial fibrillation, other factors should also be considered before anticoagulant therapy