62
Management
6.6.1. Management of Patients with AF and Intracranial
Hemorrhage
COR LOE
Recommendations
2a C-LD 1. In patients with AF and conditions associated with very high
risk of thromboembolic events (>5%/year), such as rheumatic
heart disease or a mechanical heart valve, early (1–2 weeks)
resumption of anticoagulation after ICH is reasonable to
reduce the risk of thromboembolic events.
2b C-LD 2. In patients with AF and ICH, delayed (4-8 weeks) resumption
of anticoagulation may be considered to balance the risks of
thromboembolic and hemorrhagic complications after careful
risk benefit assessment.
2b B-NR 3. In patients with AF and conditions associated with high
risk of recurrent ICH (eg, cerebral amyloid angiopathy)
anticoagulation-sparing strategies (eg, LAAO) may be
considered to reduce the risk of recurrent hemorrhage.
Table 17. Risk Factors for Thromboembolic Complications
and Recurrent ICH
Factors Associated With High
Risk of Thromboembolism
Factors Associated With High Risk of
Recurrent ICH
Mechanical heart valve Suspected cerebral amyloid angiopathy
Rheumatic valve disease Lobar intraparenchymal hemorrhage (IPH)
Previous history of stroke/
thromboembolism
Older age
Hypercoagulable state (eg, active
malignancy, genetic thrombophilia)
>10 cerebral microbleeds on MRI
High CHA
2
DS
2
-VASc score (>5) Disseminated cortical superficial siderosis on MRI
Poorly controlled hypertension
Previous history of spontaneous ICH
Genetic/acquired coagulopathy
Untreated symptomatic vascular malformation
or aneurysm
