Atrial fibrillation after brain hemorrhage

Patients with atrial fibrillation (a heart rate disorder) often take anticoagulants to prevent cerebral vascular accidents ( stroke ) caused by clots. However, when a person has already survived a cerebral hemorrhage (a serious form of stroke caused by bleeding in the brain), the resumption of these drugs raises a delicate question: do benefits exceed the risks?

A major European study, called Prestige-AF , tried to answer this question. It followed 319 patients in 6 European countries, all with atrial fibrillation and having survived a cerebral hemorrhage. These patients were randomized in two groups: one received a direct oral anticoagulant (Doac) , the other did not receive it.

• The patients treated with a doac had much fewer ischemic stroke (caused by clots) than those who did not take them.
• But , these same patients had much more recurrence of cerebral hemorrhage , a serious side effect.
• In simple terms: the drug protects against one type of stroke but increases the risk of another .
• The serious side effects were generally a little less frequent in the under anticoagulant group.

In people who have already had brain hemorrhage, doacs can be very effective in preventing strokes linked to atrial fibrillation (embolism), but significantly increase the risk of recurrence of cerebral hemorrhage. Researchers point out that it will take even more studies and perhaps new approaches (drug or mechanical) to protect these high-risk patients without exposing them to new dangers.