How to manage anticoagulation in patient with hemorrhagic stroke and atrial fibrillation ?
The optimum timing is 7-8 weeks.
However, other factors like the size of the hemorrhage and CHADSVasc score may play a role in the decision
Also patient shared decision making is imrportant here as they are at a higher risk of another ICH
Patient CHAD- VASC score and the size of the hemorrhage may influence the decision in which DOAC to prescribe.
Actually It's very much rare association, commonly AF with Ischemic stroke,
but when hemorrhagic stroke with AF, we have to think about risk benefit ratio, considering HAS-BLED score & CHADVASc score. So far i know in that case anticoagulant must have STOP as because more chances of bleeding.
Actually this is paradox scenerio, AF is usually associated with Ischaemic stroke we have to consider risk benefit ratio in such situation , use of anticoagulant further increases the hemorrhagic size in case of uncontrolled AF with hemodynamic compromise or patient on prosthetic valve .we can use Fresh frozen plasma if INR is highly deranged. even we can stop anticoagulant for 4-6 week if Patient having controlled AF .
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