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Comment & Response
August 20, 2019

Resuming Anticoagulation After Cerebral Intraparenchymal Hemorrhage

Author Affiliations
  • 1Department of Neurology, Yale School of Medicine, New Haven, Connecticut
JAMA. 2019;322(7):694. doi:10.1001/jama.2019.8650

To the Editor Dr Gross and colleagues reviewed the management options for cerebral intraparenchymal hemorrhage (IPH) to help guide clinical decision-making.1 The review captured the most up-to-date evidence for clinical management of IPH; however, the authors’ suggestion to resume oral anticoagulation therapy 1 to 2 months after deep IPH unrelated to cerebral amyloid angiopathy may not be supported by firm evidence. We believe the recommendations should be more cautious. The 2015 American Heart Association guidelines do not provide a definitive recommendation for resumption of anticoagulation therapy after nonlobar IPH.2 In the absence of results from randomized clinical trials, the safety and optimal timing of restarting oral anticoagulation therapy in patients with IPH remains unknown.

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