Thrombosis and Haemostasis
Author Interview
Stroke, Systemic or Venous Thromboembolism
Truman J. Milling Jr., Ben King, Patrick Yue, Saskia Middeldorp, Jan Beyer-Westendorf, John W. Eikelboom, Mark Crowther, Lizhen Xu, Peter Verhamme , Deborah M. Siegal, Stuart J. Connolly, on behalf of the ANNEXA-4 Investigators
CC BY-NC-ND 4.0 · Thromb Haemost 2021; 121(08): 1097-1106, DOI: 10.1055/a-1400-6159
T&H
Why did you (and your colleagues) write this paper? What was its main purpose?
TRUMAN MILLING
We saw the obvious finding that thrombotic events did not occur when clinicians restarted anticoagulation after major hemorrhage, and we wanted to explore this further.
T&H
What was its main purpose?
TRUMAN MILLING
To begin to provide the evidence to move clinicians off their conservative bias toward anticoagulation decisions after major bleeding. We, patients and clinicians, naturally fear bleeding more than thrombosis, and we shouldn't.
T&H
What are the main conclusions?
TRUMAN MILLING
We found weak evidence of net clinical benefit to restarting.
T&H
What are the paper's implications? - to the public? -to medical professionals?
TRUMAN MILLING
Randomized clinical trials in various major bleeding scenarios, e.g. traumatic and spontaneous ICH, GI bleeding, etc., should be carried out to confirm these findings.
T&H
Are the findings clinically significant? Should the findings change practice?
TRUMAN MILLING
The findings are significant, but randomized trials are needed to change practice. There are several ongoing or about to start, Restart TICrH, ENRICH AF and SoStart to name a few.
Invited Editorial Focus
Balancing Risks and Benefits When Recommencing Oral Anticoagulants after Major Bleeding
Ellie Edlmann, Catherine McMahon
