Hervatten van antistolling na een hersenbloeding

Abstract

There is no evidence from randomised clinical trials with regard to the question if and when to resume antithrombotic medication in patients who have suffered an intracerebral haemorrhage and in whom medication continues to be indicated. It is unknown whether new oral anticoagulants are more suitable than vitamin K antagonists in this group of patients. Oral anticoagulants should probably not be resumed in patients with a lobar intracerebral haemorrhage caused by cerebral amyloid angiopathy. They can be considered in patients with a haemorrhage in subcortical regions of the brain, the brain stem or the cerebellum, provided that blood pressure levels are under control. Depending on the risk of a cardiac embolus, antithrombotic medication can be resumed from 1 to 10 weeks after the intracerebral haemorrhage. In patients with atrial fibrillation this risk can be calculated using the CHA2DS2-VASc score. In patients with a cardiac indication for antithrombotic medication the decision whether or not to resume medication should be made by a cardiologist and a neurologist in collaboration.