Avoiding Anticoagulation After IntraCerebral Haemorrhage

Inclusion criteria - Adult (older than 18 years old, no upper age limit) - with a history of paroxysmal, persistent or long-standing non-valvular atrial fibrillation (documented on an electrocardiogram) - and a CHA2DS2VASc score of 2 or more who have an indication for long-term anticoagulation - who suffered from a spontaneous intracerebral haemorrhage (while being treated with oral anticoagulants or not) documented with brain CT or MRI - more than 14 days before randomization (no upper delay limit) - for whom there is a clinical equipoise regarding the choice of the best preventive strategy to avoid future vascular events. Exclusion criteria for all treatment groups - Pre-randomisation modified Rankin score of 4 or 5 - Conditions other than atrial fibrillation for which the patient requires long term anticoagulation (for example prosthetic mechanical heart valve) - Serious bleeding events within the 6 months before randomisation (except for intracerebral haemorrhage) - Life expectancy of less than 1 year - Pregnancy or breastfeeding Exclusion criteria related to the LAAC only - Contraindications due to local, anatomical reasons (such as thrombus in the left atrial appendage, infection with a risk of endocarditis) - Patients older than 85 years - CHA2DS2VASc score of 2 or 3 - Patient or attending physician are unwilling to undergo/perform intervention for LAAC Exclusion criteria related to the Direct OAC only - Chronic renal insufficiency (clearance of creatinine by Cockcroft method \< 30ml/min) - Body weight lower than 50 kg - Allergy to apixaban - Coexisting conditions predisposing to head trauma (e.g. gait disturbances, uncontrolled seizures disorders) - Patient or attending physician are unwilling to use of Direct OAC Always talk to your doctor about whether this trial is right for you.