Response by Murthy et al to Letter Regarding Article, “Restarting Anticoagulant Therapy After Intracranial Hemorrhage: A Systematic Review and Meta-Analysis”
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We thank Barco et al for taking interest in our study.1 The authors highlight important limitations of our study, which though acknowledged in detail are critical to the generation of new knowledge for intracranial hemorrhage (ICH) and stroke prevention and, therefore, worth re-emphasis. We would like to reiterate that our aim was to perform the most rigorous possible evaluation of the existing data using meta-analysis guidelines.
Given the absence of large, randomized clinical trials, it is clear that we need more data to develop firm scientific ground for decision making around (1) location of bleed (lobar versus deep), (2) differential cardiovascular risk (atrial fibrillation, mechanical valve, venous thromboembolism), and (3) competing risk of ICH, ischemic disease, and ICH-related mortality. Each of these populations may carry different risks of bleeding and ischemia, altering …