Anticoagulation Restart After ICH — RACP Adult Medicine MCQ
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Correct answer: C — 2–4 weeks after neurosurgery with MDT discussion
Restarting anticoagulation after intracranial haemorrhage is a complex risk-benefit decision that should involve neurosurgery, haematology, and the treating physician (MDT approach). Current evidence (RESTART trial – ischaemic stroke cohort) suggests that restarting anticoagulation 2–4 weeks after ICH in patients with AF reduces ischaemic stroke risk without significantly increasing recurrent ICH risk. The timing depends on the type of haemorrhage (lobar vs deep), surgical factors, and individual bleeding/thrombotic risk assessment. Earlier restart (7–14 days) may be considered for high thromboembolic risk; later restart (4–8 weeks) for high rebleeding risk.
Reference: eTG – 2025 – Haematology; Stroke Foundation – 2024 – Clinical Guidelines