Background: Intracerebral hemorrhage is the pathological accumulation of blood within the brain. It is
a type of stroke more likely to be lethal or to severely disable the patient and results from a wide variety of
causes. On the other hand antithrombotic therapy is used for the prevention or/and the therapy of thromboembolic
episodes. Antithrombotic drugs are very effective in reducing risk or mortality rate after a thromboembolic event,
yet they are associated with significant hemorrhages.
Objective: The aim of this article is to review current literature for intracerebral hemorrhage and antithrombotic
therapy and offer recommendations on the reversal, the discontinuation and the resumption of antithrombotic
Methods and Materials: Current literature has been reviewed for intracerebral hemorrhage associated with three
major categories of patients, those with atrial fibrillation, those with prosthetic mechanical valves and those with
venous thromboembolism. Antithrombotic therapy is categorized in antiplatelet agents and anticoagulants. The
risk of intracerebral hemorrhage, of a thromboembolic event and of a rebleeding with or without antithrombotic
therapy was also reported.
Conclusion: Although no one can deny the usefulness of antithrombotic therapy a therapeutic strategy should be
developed in order to optimize the clinical decision of stopping, reversing and restarting antithrombotic treatment.
This review concludes in strong recommendations, yet a multidisciplinary panel by a stroke physician or neurologist,
a cardiologist, a neuroradiologist and a neurosurgeon should evaluate the benefits and the risks for each
patient and decide the best therapeutic strategy.