Avoiding Anticoagulation After IntraCerebral Haemorrhage

Inclusion criteria

• Adult (older than 18 years old, no upper age limit)

• with a history of paroxysmal, persistent or long-standing non-valvular atrial fibrillation (documented on an electrocardiogram)

• and a CHA2DS2VASc score of 2 or more who have an indication for long-term anticoagulation

• who suffered from a spontaneous intracerebral haemorrhage (while being treated with oral anticoagulants or not) documented with brain CT or MRI

• more than 14 days before randomization (no upper delay limit)

• for whom there is a clinical equipoise regarding the choice of the best preventive strategy to avoid future vascular events.

Exclusion criteria for all treatment groups

• Pre-randomisation modified Rankin score of 4 or 5

• Conditions other than atrial fibrillation for which the patient requires long term anticoagulation (for example prosthetic mechanical heart valve)

• Serious bleeding events within the 6 months before randomisation (except for intracerebral haemorrhage)

• Life expectancy of less than 1 year

• Pregnancy or breastfeeding

Exclusion criteria related to the LAAC only

• Contraindications due to local, anatomical reasons (such as thrombus in the left atrial appendage, infection with a risk of endocarditis)

• Patients older than 85 years

• CHA2DS2VASc score of 2 or 3

• Patient or attending physician are unwilling to undergo/perform intervention for LAAC

Exclusion criteria related to the Direct OAC only

• Chronic renal insufficiency (clearance of creatinine by Cockcroft method < 30ml/min)

• Body weight lower than 50 kg

• Allergy to apixaban

• Coexisting conditions predisposing to head trauma (e.g. gait disturbances, uncontrolled seizures disorders)

• Patient or attending physician are unwilling to use of Direct OAC