Restarting anti-coagulation after Haemorrage

T&H: Why did you (and your colleagues) write this paper?

TRUMAN MILLING: We saw the obvious finding that thrombotic events did not occur when clinicians restarted anticoagulation after major hemorrhage, and we wanted to explore this further.

What was its main purpose?

T.M: To begin to provide the evidence to move clinicians off their conservative bias toward anticoagulation decisions after major bleeding. We, patients and clinicians, naturally fear bleeding more than thrombosis, and we shouldn't.

What are the main conclusions?

T.M: We found weak evidence of net clinical benefit to restarting.

What are the paper’s implications?- to the public?-to medical professionals?

T.M: Randomized clinical trials in various major bleeding scenarios, e.g. traumatic and spontaneous ICH, GI bleeding, etc., should be carried out to confirm these findings.

Are the findings clinically significant? Should the findings change practice?

T.M: The findings are significant, but randomized trials are needed to change practice. There are several ongoing or about to start, Restart TICrH, ENRICH AF and SoStart to name a few.

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