Re-initiation of oral-anticoagulants in survivors of hemorrhagic stroke

Intra-cerebral hemorrhage (ICH) is the most feared and the deadliest complication of oral anticoagulant therapy, i.e. warfarin (Coumadin). After such an occurrence, clinicians wonder whether their patients should resume anticoagulant therapy. The decisions to reverse and re-initiate anticoagulation hinge on the phase of stroke as the risk of thromboembolism outweighs risk of bleeding in the chronic phase. Hence in the short term, most patients with ICH will benefit from acute reversal of anticoagulation, followed by gradual reinstitution of prophylactic-dose anticoagulation after first 24-72 h. The underlying cause of stroke should guide the long-term management.