Kuramatsu JB, et al. - Researchers herein focused on anticoagulation reversal and resumption strategies in patients with intracerebral haemorrhage (ICH) and implanted mechanical heart valves (MHVs), to define an optimal time-window when to restart therapeutic anticoagulation (TA) in such cases. Increased haemorrhagic complications were noted in relation to restarting TA within less than 2 weeks after ICH in patients with MHV. Also, it was noted that optimal weighing—between least risks for thromboembolic and haemorrhagic complications—offered an earliest starting point of TA at Day 6, reserved only for patients at high thromboembolic risk.

• From a nationwide multicentre cohort-study (RETRACE, conducted at 22 German centres), researchers pooled individual patient-data (n = 2504) and eventually identified MHV-patients (n = 137) with anticoagulation-associated ICH for outcome analyses.
• Major haemorrhagic complications analysed during hospital stay according to treatment exposure (restarted TA vs no-TA) was the primary outcome.
• Secondary outcomes comprised thromboembolic complications, the composite outcome (haemorrhagic and thromboembolic complications), timing of TA, and mortality.
• Also, adjusted analyses were performed, that involved propensity-score matching and multivariable cox-regressions to identify optimal timing of TA.

• Researchers found that TA was restarted in 66/137 (48%) of patients.
• They also noted that restart of TA was associated with increased haemorrhagic complications (TA = 17/66 (26%) vs no-TA = 4/71 (6%); P < 0.01) and with a trend to decreased thromboembolic complications (TA = 1/66 (2%) vs no-TA = 7/71 (10%); P=0.06).
• Findings demonstrated that controlling treatment crossovers offered an incidence rate-ratio [hazard ratio (HR) 10.31, 95% confidence interval (CI) 3.67–35.70; P < 0.01] in disadvantage of TA for haemorrhagic complications.
• In addition, significant harm was shown in analyses of TA-timing until Day 13 after ICH (HR 7.06, 95% CI 2.33–21.37; P < 0.01).
• It was also noted that the hazard for the composite—balancing both complications, was increased for restarted TA until Day 6 (HR 2.51, 95% CI 1.10–5.70; P=0.03).