Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials

作者：Rustam Al‐Shahi Salman, Jacqueline Stephen, Jayne F. Tierney, Steff Lewis, David E. Newby, Adrian Parry‐Jones, Phil White, Stuart J. Connolly, Oscar Benavente, Dar Dowlatshahi, Charlotte Cordonnier, Catherine M. Viscoli, Kevin N. Sheth, Hooman Kamel, Roland Veltkamp, Kristin T Larsen, Jeannette Hofmeijer, Henk Kerkhoff, Floris H.B.M. Schreuder, Ashkan Shoamanesh, Catharina J.M. Klijn, H. Bart van der Worp, Didier Klug, Barbara Casolla, Laurent Puy, Morgane Coffee, Grégory Kuchcinski, Julien Labreuche, Koen M. van Nieuwenhuizen, Ale Algra, Isabelle C. Van Gelder, L. Jaap Kappelle, Gabriël J.E. Rinkel, Roger E. G. Schutgens, Pooja Khatri, Robin Conwit, Guido J. Falcone, Jordan Elm, Craig S. Anderson, Lili Song, Jeyaraj Pandian, Robert G. Hart, Mukul Sharma, Hany Aref, Wadea Tarhuni, J. Martí Fàbregas, Hans‐Christoph Diener, Matthias Endres, Robin Lemmens, Sun U. Kwon, Byung‐Chul Lee, Sebastián F. Ameriso, Truman J. Milling, Scott E. Kasner, Robert Mikulík, Denis Xavier, Ronny Beer, Danilo Toni, Jens Eckstein, David Seiffge, José M. Ferro, Georgios Tsivgoulis, Sanjib Kumar Sharma, Chia Wei-Liou, Stefan H. Hohnloser, Aristeidis H. Katsanos, Jackie Bosch, Jeff S. Healey, John W. Eikelboom, Alexander V. Khaw, David J. Gladstone, Aleksandra Pikula, Shelagh B. Coutts, Eric E. Smith, Kenneth Butcher, Thalia S. Field, Laura Gioia, Christian Stapf, Omid Halse, Peter Ringleb, Christian Enzinger, Igor Sibon, Joan Montaner, Valeria Caso, Peter U. Heuschmann, Gregory Y.H. Lip, Walter E. Haefeli, Stefanie Debette, Martin Dennis, Torgeir Bruun Wyller, Ole Morten Rønning, Helle Eilertsen, Hege Ihle‐Hansen, Else Charlotte Sandset, Johanna Pennlert, Eva‐Lotta Glader, Christina Kruuse, Per Wester, Maria Carlsson, Elisabeth Forfang · 发表于：The Lancet Neurology · 年份：2023 · DOI：10.1016/s1474-4422(23)00315-0 · 被引用次数：66 · 研究领域：Atrial Fibrillation Management and Outcomes、Intracerebral and Subarachnoid Hemorrhage Research、Acute Ischemic Stroke Management

Background The safety and efficacy of oral anticoagulation for prevention of major adverse cardiovascular events in people with atrial fibrillation and spontaneous intracranial haemorrhage are uncertain. We planned to estimate the effects of starting versus avoiding oral anticoagulation in people with spontaneous intracranial haemorrhage and atrial fibrillation. Methods In this prospective meta-analysis, we searched bibliographic databases and trial registries using the strategies of a Cochrane systematic review (CD012144) on June 23, 2023. We included clinical trials if they were registered, randomised, and included participants with spontaneous intracranial haemorrhage and atrial fibrillation who were assigned to either start long-term use of any oral anticoagulant agent or avoid oral anticoagulation (ie, placebo, open control, another antithrombotic agent, or another intervention for the prevention of major adverse cardiovascular events). We assessed eligible trials using the Cochrane Risk of Bias tool. We sought data for individual participants who had not opted out of data sharing from chief investigators of completed trials, pending completion of ongoing trials in 2028. The primary outcome was any stroke or cardiovascular death. We used individual participant data to construct a Cox regression model of the time to the first occurrence of outcome events during follow-up in the intention-to-treat dataset supplied by each trial, followed by meta-analysis using a fixed-effe...