Clinical characteristics arguing for or against resuming anticoagulation after major bleeding
| Clinical characteristic . | For . | Against . |
|---|---|---|
| Bleed-related characteristics | ||
| Known, correctable source | +++ | |
| Known, uncorrectable source | + | |
| Unknown source | + | |
| Deep ICH location, blood pressure–controlled | ++ | |
| Lobar ICH location, MRI evidence of microbleeding | + | |
| Indication for anticoagulation | ||
| Mechanical heart valve | +++ | |
| Idiopathic or recurrent VTE | +++ | |
| Provoked VTE, completed 3 mo of therapy | +++ | |
| VTE + protein C/S or antithrombin deficiency or APLA syndrome | ++ | |
| Atrial fibrillation, prior history of stroke or higher CHADS2 or CHA2DS2-VASc score | +++ | |
| Atrial fibrillation, lower CHADS2, or CHA2DS2-VASc score | + | |
| Atrial fibrillation, no additional stroke risk factors | +++ | |
| Other characteristics | ||
| History of anticoagulation therapy nonadherence | + | |
| Previously unstable INR control despite adequate adherence | + | |
| Renal failure | + | |
| Poor prognosis, limited life expectancy | + |
| Clinical characteristic . | For . | Against . |
|---|---|---|
| Bleed-related characteristics | ||
| Known, correctable source | +++ | |
| Known, uncorrectable source | + | |
| Unknown source | + | |
| Deep ICH location, blood pressure–controlled | ++ | |
| Lobar ICH location, MRI evidence of microbleeding | + | |
| Indication for anticoagulation | ||
| Mechanical heart valve | +++ | |
| Idiopathic or recurrent VTE | +++ | |
| Provoked VTE, completed 3 mo of therapy | +++ | |
| VTE + protein C/S or antithrombin deficiency or APLA syndrome | ++ | |
| Atrial fibrillation, prior history of stroke or higher CHADS2 or CHA2DS2-VASc score | +++ | |
| Atrial fibrillation, lower CHADS2, or CHA2DS2-VASc score | + | |
| Atrial fibrillation, no additional stroke risk factors | +++ | |
| Other characteristics | ||
| History of anticoagulation therapy nonadherence | + | |
| Previously unstable INR control despite adequate adherence | + | |
| Renal failure | + | |
| Poor prognosis, limited life expectancy | + |
Adapted from Goldstein and Greenberg.13
CHADS2, scoring system used to assess stroke risk based on key risk factors: congestive heart failure, hypertension, age over 75 y, diabetes mellitus, and prior stroke or transient ischemic attack; CHA2DS2-VASc, scoring system used to assess stroke risk based on same factors as CHADS2 with the addition of vascular disease age over 65 y, and female sex; MRI, magnetic resonance imaging.
+++, consider very strongly; ++, consider strongly; +, consider.