For people living with atrial fibrillation, the risk of stroke is always present. Doctors often prescribe anticoagulant medications to lower that risk. But for patients who have already suffered intracranial hemorrhage, while anticoagulants can reduce the chance of stroke, they also may increase the risk of dangerous bleeding in the brain.
Because of that risk, many people with atrial fibrillation who have had a brain hemorrhage are treated cautiously, often with antiplatelet drugs, or sometimes with no medication at all. That approach may lower the risk of bleeding, but it could leave patients vulnerable to stroke.
The ENRICH-AF trial is exploring whether it’s safe for people with atrial fibrillation who have had a brain hemorrhage to take anticoagulant medications.
Ashkan Shoamanesh
PHRI researchers are studying whether edoxaban, a widely available oral anticoagulant, can lower the risk of stroke more effectively than antiplatelet therapy or no treatment, without increasing the risk of another brain bleed. Edoxaban works by blocking factor Xa, a key protein involved in blood clot formation.
Led by PHRI senior scientist Ashkan Shoamanesh, the trial includes 947 patients from 20 countries around the world. Participants are randomly assigned to one of two groups: one receives edoxaban 30 mg once daily, while the other receives standard medical care, which may include antiplatelet therapy or no antithrombotic treatment.
By comparing these approaches, the study aims to provide clearer answers for patients and clinicians on how to lower stroke risk after a brain hemorrhage without causing harm.
Top‑line results from the ENRICH‑AF trial are expected to be shared at an international scientific meeting later this year.
