Letter by Barco et al Regarding Article, “Restarting Anticoagulant Therapy After Intracranial Hemorrhage: A Systematic Review and Meta-Analysis”
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To the Editor:
We read with interest the systematic review and meta-analysis authored by Murthy et al1 that appeared in Stroke. The authors studied the efficacy and safety of anticoagulant resumption after nontraumatic intracranial hemorrhage (ICH) and showed that resumption was associated with a lower risk of arterial thromboembolism but a similar risk of recurrent ICH. We do have some comments on their interpretation of the results.
First, all the included studies had a retrospective design and, therefore, are characterized by heterogeneity in treatment regimens and timing of anticoagulation restart. As the authors argue in their discussion, location matters for the risk of recurrent ICH: lobar bleedings are more prone to rebleeding than nonlobar bleedings. The authors could not control for this or other sources of heterogeneity by adjustment, stratification, or matching: therefore, any interpretation of causality warrants caution …