RESTART tICrH: Randomized Test of 1- vs 4-Week DOAC Resumption

This protocol describes the first randomized trial directly comparing early (1-week) versus late (4-week) direct oral anticoagulant resumption after traumatic intracranial haemorrhage, a decision currently made without high-quality evidence.

direct oral anticoagulantsDOACapixabanrivaroxabanedoxabandabigatranwarfarintraumatic intracranial haemorrhageatrial fibrillationvenous thromboembolismanticoagulation restartRCT protocolneuropharmacologygeriatric trauma Neurology / Neuropharmacology

Background Information

When should DOACs restart after brain bleeding? This trial aims to find out.

Restarting direct oral anticoagulants (DOACs) after traumatic intracranial haemorrhage (tICH) involves balancing bleeding and thrombotic risks with no current consensus on timing. The study randomizes patients to restart DOACs either 1 week or 4 weeks post-tICH, assessing outcomes like haemorrhagic or thrombotic events within 12 weeks. This trial aims to inform clinical practice by providing evidence on the optimal timing for restarting DOACs after tICH, directly impacting patient care protocols. Timely DOAC re-initiation after tICH can optimize patient outcomes, reducing bleeding and thrombotic risks.

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Authors: Edlmann E, Kannan S, Wright L, Hardwick B, Brown M, Gornall M, McLoughlin T, Haunton V, Pijeira Perez Y, Hughes DA, Vine N, Grantham H, Milling TJ, Lane DA, Lip GYH, Jenkinson MD, McMahon CJ

Citation: Edlmann E, Kannan S, Wright L, et al. Timing to restart direct oral anticoagulants after traumatic intracranial haemorrhage (RESTART tICrH): study protocol for a randomised controlled multicentre trial. BMJ open. 2026;16(9):e121224. doi:10.1136/bmjopen-2026-121224

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Executive Summary

Study Design

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