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Introduction <p>The literature extensively addresses the timing of anticoagulant therapy resumption after lobar intracerebral hemorrhage (ICH) in patients with atrial fibrillation (AF). However, there is few data for patients with lobar (atypical) ICH requiring anticoagulation for non-AF indications.</p> Cases description <p>We present two cases of non-surgical, medium-sized lobar ICH where anticoagulant therapy was resumed early: the first case involved a hypertensive patient on warfarin and clopidogrel for left ventricular thrombosis following acute myocardial infarction and coronary stenting; the second one a patient with probable cerebral amyloid angiopathy (CAA) on warfarin (INR 3.87 at onset) due to an aortic valve prosthesis. Alternative treatments to anticoagulation were not viable in either case, necessitating early resumption of therapy. During follow-up, no clinical or radiological evidence of rebleeding was observed in either patient.</p> Conclusions <p>These cases suggest that early anticoagulation resumption (within 4 weeks) may be safe in the short term, even in patients with a&#xa0;high risk of rebleeding and no alternative options. Evidence-based guidelines are urgently needed, particularly for patients with non-AF conditions.</p>

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Early anticoagulant resumption after atypical intracerebral hemorrhage: beyond atrial fibrillation analysis of two clinical cases admitted to the University Hospital of Pisa

  • 期刊论文

  • 发表日期：

    2025年6月28日

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  • Gaia Mignani,
  • Marta Del Chicca,
  • Roberto D’Agliano,
  • Marco Baldini,
  • Margherita Giannini,
  • Nicola Giannini

摘要

Introduction

The literature extensively addresses the timing of anticoagulant therapy resumption after lobar intracerebral hemorrhage (ICH) in patients with atrial fibrillation (AF). However, there is few data for patients with lobar (atypical) ICH requiring anticoagulation for non-AF indications.

Cases description

We present two cases of non-surgical, medium-sized lobar ICH where anticoagulant therapy was resumed early: the first case involved a hypertensive patient on warfarin and clopidogrel for left ventricular thrombosis following acute myocardial infarction and coronary stenting; the second one a patient with probable cerebral amyloid angiopathy (CAA) on warfarin (INR 3.87 at onset) due to an aortic valve prosthesis. Alternative treatments to anticoagulation were not viable in either case, necessitating early resumption of therapy. During follow-up, no clinical or radiological evidence of rebleeding was observed in either patient.

Conclusions

These cases suggest that early anticoagulation resumption (within 4 weeks) may be safe in the short term, even in patients with a high risk of rebleeding and no alternative options. Evidence-based guidelines are urgently needed, particularly for patients with non-AF conditions.