Should anticlotting drugs for AF be given to people who’ve had a brain haemorrhage?

Start or STop Anticoagulants Randomised Trial (SoSTART) for atrial fibrillation after intracranial haemorrhage: safety phase

Atrial fibrillation is the most common form of irregular heart rhythm. It is more common in the elderly and is associated with a much higher risk of stroke – when a clot blocks blood supply to part of the brain. For that reason, most people with AF are given anti-clotting drugs as an effective way to lower their risk of stroke. However, as anti-clotting drugs also increase the risk of bleeding, it’s not clear if people with AF who have had a brain haemorrhage should be given anti-clotting drugs to lower their risk of stroke. We don’t know if this treatment will leave them at too high a risk of another bleed in the brain. This grant will support the first safety phase of a clinical trial called the Start or Stop Anticoagulants Randomised Trial, or SoSTART for short. The team will recruit 190 people with AF who’ve had a brain haemorrhage. Half of them will be given or restarted on anticlotting drugs and half of them won’t be given anticlotting drugs. The participants will be followed up for a least a year to check that starting anticlotting drugs does not cause a big increase in the risk of another bleed in the brain. If blood-thinners are shown not to cause a big increase in the risk of bleeding in these people, the team will seek funding for a main phase of SoSTART. However, if the risk is shown to be too high, the results will immediately show doctors that people who’ve had a brain haemorrhage should not be prescribed anticlotting drugs for AF.