Table 3.

OACs resumption modalities according to ICH subtype.

ICH-Clinical Features	Physiolopatology	Risk of recurrence	OACs resumption decision-making	OACs resumption
Lobar ICH	Strictly related to CAA, with the characteristic presence of amyloid-β, micro-hemorrhages, and fragile vessel structure	Very high risk of recurrence. A genetic apolipoprotein E association in CAA-related lobar ICH has been described as a cause of the recurrence of ICH.	OACs resumption decision-making is challenging and it should be followed a comprehensive diagnostic work-up including a magnetic resonance, in order to identify microbleeds and neuroimaging markers for increased hemorrhagic risk such as cSS or cSAH.	–f CAA is suspected and in the presence of a microbleeds burden > 5, OACs should be avoided, and alternative strategies should be considered –If CAA is not probable and a microbleeds burden < 5 occurs, OAC should be restarted between 4 and 8 weeks after ICH should be restarted according to the patients's individual thromboembolic/hemorrhagic risk evaluation. DOACs over VKA should be preferred
Non-lobar ICH	Hypertensive vasculopathy	Lower than lobar location	A secondary ICH etiology should be excluded.	OACs regimen between 4 and 8 weeks after ICH should be restarted according to the patients’ individual thromboembolic/hemorrhagic risk evaluation. DOACs over VKA should be preferred
ICH in patients with mechanical heart valves	Altered, non-therapeutic coagulation		Challenging due to the high risk of ischemic events, and VKA are the only option.	OACs should not be restarted earlier than six days after the initial ICH. In patients with high thrombotic risk (concomitant AF, mitral position, or older prosthesis types) OACs may be restarted after one week. OACs Resumption after 13 days from ICH is generally considered safe.

ICH: intracranial hemorrhage; CCA: cerebral amyloid angiopathy; cSS; cortical superficial siderosis; cSAH: cortical or convexity subarachnoid hemorrhage; OACs: oral anticoagulants.