{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:40:19Z","timestamp":1792662019047,"version":"4.5.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Optimal secondary stroke prevention remains uncertain for patients with intracerebral hemorrhage (ICH) and atrial fibrillation (AF). Anticoagulation reduces ischemic stroke in AF but increases hemorrhage. Left atrial appendage (LAA) occlusion is emerging as an alternative to anticoagulation, but few data exist on its safety in patients with ICH. Amid this uncertainty, little is known about US practice patterns in this scenario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      We performed a study using linked electronic health record, pharmacy, and insurance claims data on &gt;11 million patients at 29 US healthcare organizations, each with multiple hospital sites, in the TriNetX Linked platform. Validated\n                      <jats:italic toggle=\"yes\">International Classification of Diseases, Tenth Revision<\/jats:italic>\n                      codes were used to identify adults with AF hospitalized for ICH during 2016 to 2024. To identify antiplatelet and anticoagulant prescriptions, we used RxNorm codes, a standardized drug naming system from the National Library of Medicine. LAA occlusion was defined using validated\n                      <jats:italic toggle=\"yes\">Current Procedural Terminology<\/jats:italic>\n                      codes. Kaplan-Meier statistics were used to calculate cumulative rates of therapy utilization from discharge through 5 years. We created 3 mutually exclusive treatment groups with censoring at LAA occlusion for analyses of antiplatelet and anticoagulant therapy and at anticoagulation for analyses of antiplatelet therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      We identified 2276 patients with AF hospitalized with ICH. Their mean age was 65.4 (\u00b112.8) years, 40.6% were female, median CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score was 5 (interquartile range, 5\u20136), 19.6% had Medicare, 26.9% received an anticoagulant prescription within 90 days before ICH, and half were discharged home or to an acute rehabilitation facility. Cumulative 5-year rates were 59.8% (95% CI, 55.5%\u201364.2%) for anticoagulation, 39.9% (95% CI, 34.1%\u201346.3%) for antiplatelet therapy, and 4.5% (95% CI, 2.6%\u20137.6%) for LAA occlusion. LAA occlusion rates did not differ by index ICH date (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.88).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In a contemporary, multicenter US cohort of patients with ICH and AF, 60% were prescribed anticoagulation after discharge, and the remainder were mostly treated with antiplatelet therapy only. These findings suggest widespread use of different secondary stroke prevention strategies in patients with AF and ICH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.055458","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:01:36Z","timestamp":1792659696000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Contemporary US Practice Patterns Regarding Anticoagulation and LAA Closure in ICH Survivors With Atrial Fibrillation"],"prefix":"10.1161","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5745-0307","authenticated-orcid":true,"given":"Hooman","family":"Kamel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0703-1972","authenticated-orcid":true,"given":"Catherine","family":"Viscoli","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale School of Medicine, New Haven, CT (C. Viscoli, P.K., H.B., K.N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Francois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7344-8266","authenticated-orcid":true,"given":"Pooja","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale School of Medicine, New Haven, CT (C. Viscoli, P.K., H.B., K.N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4893-8474","authenticated-orcid":true,"given":"Jordan","family":"Elm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6891-750X","authenticated-orcid":true,"given":"Steven","family":"Feske","sequence":"additional","affiliation":[{"name":"Department of Neurology, Boston University School of Medicine, MA (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Bachmann","sequence":"additional","affiliation":[{"name":"Cottage Health Research Institute, Santa Barbara, CA (A.B., L.G.-C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"Gama-Chonlon","sequence":"additional","affiliation":[{"name":"Cottage Health Research Institute, Santa Barbara, CA (A.B., L.G.-C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9075-7662","authenticated-orcid":true,"given":"Hailey","family":"Brigger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale School of Medicine, New Haven, CT (C. Viscoli, P.K., H.B., K.N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0797-3668","authenticated-orcid":true,"given":"Giovanni","family":"Bianco","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurology Department, Neurocentro della Svizzera Italiana (INSI), EOC, Lugano, Switzerland (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4950-0992","authenticated-orcid":true,"given":"Santosh","family":"Murthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8059-2901","authenticated-orcid":true,"given":"David L.","family":"Tirschwell","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Washington, Seattle (D.L.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Shaban","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Carver College of Medicine (A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1595-0602","authenticated-orcid":true,"given":"Blake A.","family":"Buletko","sequence":"additional","affiliation":[{"name":"Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7917-6142","authenticated-orcid":true,"given":"Chitra","family":"Venkatasubramanian","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stanford Medicine, Palo Alto, CA (C. Venkatasubramanian)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2003-5473","authenticated-orcid":true,"given":"Kevin N.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale School of Medicine, New Haven, CT (C. Viscoli, P.K., H.B., K.N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.0190"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.1991"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25079"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.49017"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-24-02132"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae398"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00315-0"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00333-2"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00366-6"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000407"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.124.070361"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad035"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.70198"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.050359"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.024092"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000116"},{"key":"e_1_3_3_20_2","first-page":"1448","article-title":"Validation and enhancement of a computable Medication Indication Resource (MEDI) using a large practice-based dataset.","volume":"2013","author":"Wei WQ","year":"2013","unstructured":"Wei WQ, Mosley JD, Bastarache L, Denny JC. Validation and enhancement of a computable Medication Indication Resource (MEDI) using a large practice-based dataset. AMIA Annu Symp Proc. 2013;2013:1448\u20131456","journal-title":"AMIA Annu Symp Proc"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad062"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.121.008418"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.122.009215"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.014643"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2022.101037"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.9369"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015735"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.126.055458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:01:37Z","timestamp":1792659697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.126.055458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":27,"alternative-id":["10.1161\/STROKEAHA.126.055458"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.126.055458","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]},"assertion":[{"value":"2026-01-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-10","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"STROKEAHA.126.055458"}}