I would emphasise that this information and study ONLY applies to those who have had 2 specific types of Cranial bleeds and have AF and looks at the risks for these people versus net benefit resulting in a caution to doctors.
At the same time, investigators of a fifth still-ongoing study of oral anticoagulation in ICH patients with AF – the ENRICH-AF study – announced that the trial's data safety monitoring board has recommended that patients with two particular types of ICH (lobar intracranial hemorrhage and convexity subarachnoid hemorrhage) stop receiving the anticoagulant being tested (edoxaban) and that no further patients with these types of ICH be enrolled into the study because of an "unacceptably high risk of recurrent hemorrhagic stroke" in those assigned to the edoxaban group.
The ENRICH-AF investigators reported this in a letter to The Lancet published online on October 12.
I know we have a few posters who have had intercranial bleeds so this information may be helpful to them, it’s not to scare those who take anticoagulants or start a discussion. Interesting though that Endoxaban is specifically mentioned.
Although the word starts with ‘anti’ - I am most definitely Pro!
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Thanks for posting. Important stuff. Hopefully more have read the Medscape paper than are responding, because it not only suggests caution with AC's/thinners in select groups, but also give some reassurance for other groups.
One takeaway is that the current CHADS risk score is a simplification by design with only modest predictive value whether or not someone should take thinners. And that last sentence is a paraphrase of what Dr. Lipp has written, one of the developers of the CHADS score itself.
So until one day perhaps AI will analyze the many, many factors that go into the thinner decision (some current formulas have up to 27 variables) and give us a more predictive formula, our best bet is to make a shared medical decision relying heavily on the advice of a good clinician who will supplement the current CHADS score with other study data, including the data contained in your post.
But by the nature of the beast, that decision may be different with different ep's, on the same hypothetical patient and that is ok because good medicine at this point in time is not robotic and good minds can differ.
I am probably one of the "posters who have had intracranial bleeds" you highlighted. And, after a bit of research into the two serious inner brain bleeds mentioned, it seems I have dodged this particular bullet. Phew! My bleeds were subdural, and involved bleeding between the outer layers of the brain (Medically described as (unexplained) chronic bilateral subdural haematomas). Still life threatening, but the two bleeds mentioned in the warning do seem much more lethal, if such an unwanted scale were to exist. But what do I know! 🤔
Regardless, I could certainly feel the wind as the bullet passed!
Your Post research has certainly helped inform my anticoagulation choice further, and gives further confirmation that anticoagulation does decrease stroke and bleed risks, except for the 2 intracranial bleeds mentioned in the warning.
My current thinking from recent research also acknowledges that a full dose Apixaban (as was recommended for me) is more effective than the half-dose option I thought might be an alternative.
I notice however that the ENRICH-AF study still has a way to go before presenting it's final conclusions re AF and intracranial brain bleeds.
Hi, how do you know if you have cranial bleeds. I was told I had a stroke last year, but because of pacemaker they wouldn't do MRI, CT scans were clear. Heart consultant said that without MRI it could not be determined whether it was a stroke or something else. Stroke consultant basically said piss off I know what I'm talking about.
When I had TIA I had contrast CT first - to rule out bleed stroke, then MRI for clots. I then had 2 follow up MRIs ordered by my neurologist 6 months & 12 months later.
I’ve had MRI with pacemaker, it’s a bit of hassle for Radiology so they tend to group PMs together & do them all in one day.
This warning was for a particular type of bleed and in a very specific part of the brain so I think you would have been told if it was either of these types of bleeds.
PS - my brother had 2 brain bleeds requiring surgery - he collapsed for no reason - you would have symptoms that a neurologist would recognise quickly.
I have had nothing you 've had, I got what A&E could offer, lots of can you swallow, what's the date. who's the PM and told I should be on statins. No face to face with consultant phone only.
It might be a help if I could see a neurologist but stroke consultant, will not assist and will not refer me to another hospital with a more up to date MRI.
Seems to me that quite a lot of stroke issues manifest themselves over time, so a call back would seem sensible, but again consultant has blocked that. Asked GP about brain bleed he said I' d collapse so no need to worry until it happens.
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