In Reply We agree with Ms Leasure and Dr Sheth that there is no firm evidence to support timing of restarting anticoagulation therapy following IPH, particularly for new-generation anticoagulants. We stated in our review1 that restarting anticoagulation therapy should be delayed by 1 to 2 months in patients with nonlobar IPH unrelated to amyloid angiopathy, but we did not state that anticoagulation therapy must be restarted in all cases at this time. In patients with a correctable etiologic cause of IPH and stronger indications for anticoagulation therapy, such as mechanical heart valves, anticoagulation therapy may need to be restarted even sooner. As Leasure and Sheth acknowledge, we summarized the available evidence to date, including a meta-analysis reinforcing the intuitive reduction of thromboembolic complications in patients resuming anticoagulation therapy.2 We agree that results of forthcoming trials will prove particularly useful in providing more rigorous evidence for future guidelines.
Gross BA, Jankowitz BT, Friedlander RM. Resuming Anticoagulation After Cerebral Intraparenchymal Hemorrhage—Reply. JAMA. 2019;322(7):694–695. doi:10.1001/jama.2019.8658
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