--- title: "When to Restart DOACs After Traumatic Intracranial Haemorrhage: The RESTART tICrH Randomised Trial" id: "bmj-open-10-timing-to-restart-direct-oral-anticoagulants-after-traumatic-intracranial" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-10-timing-to-restart-direct-oral-anticoagulants-after-traumatic-intracranial" content_type: "clinical_feed_article" specialty: "Neurology" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/9/e121224?rss=1" published_at: "2026-09-17T10:23:27.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # When to Restart DOACs After Traumatic Intracranial Haemorrhage: The RESTART tICrH Randomised Trial ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-10-timing-to-restart-direct-oral-anticoagulants-after-traumatic-intracranial - **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/9/e121224?rss=1) - **Published At:** 2026-09-17T10:23:27.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - Older adults increasingly present with head injury from low-impact falls; many are taking **oral anticoagulants (OACs)** at the time of injury. Stopping OACs reduces rebleeding risk but prolongs interruption and raises stroke, thromboembolism and mortality risk. - There is no consensus on optimal timing to resume anticoagulation after **traumatic intracranial haemorrhage (tICH)**. - RESTART tICrH is a phase III, multicentre, randomised controlled trial across approximately 20 UK trauma networks comparing two restart timings for **direct oral anticoagulants (DOACs)**: 1 week versus 4 weeks after tICH. - Eligible adults had been taking an OAC before injury. Participants are randomised to one of the two restart strategies. - The primary endpoint is the proportion of patients experiencing a haemorrhagic or thrombotic event within 12 weeks of tICH. - Key secondary endpoints: time-to-first haemorrhagic or thrombotic event, survival, functional status, quality of life, and health resource use. - Follow-up occurs at 6, 12 and 26 weeks. Analyses use an intention-to-treat approach. - Health economic and qualitative substudies will run alongside the main trial to inform cost-effectiveness and patient perspectives. - Ethical approval was granted by Berkshire Research Ethics Committee (24/SC/0298); written informed consent is required from participants or legal representatives. - Results will be shared via peer-reviewed publications, conferences, trial registry reports and patient-facing summaries to inform clinical practice and guidelines. - Trial registration: NCT06322953. ## Clinical Analysis & Structured Key Points Background Head injury in older adults is increasingly common, often caused by low-impact falls. A significant proportion of these patients are taking oral anticoagulants (OACs) to prevent stroke or thromboembolism. When traumatic bleeding within the head occurs, OACs are usually stopped to reduce the risk of worsening haemorrhage; however, prolonged interruption increases the risk of stroke, systemic thromboembolism and death. There is currently no consensus on when it is safest to restart OACs. Direct oral anticoagulants (DOACs) are now widely prescribed and may offer advantages over warfarin. This trial aims to determine the safest and most effective timing to start/restart a DOAC after a traumatic intracranial haemorrhage (tICH). Methods This is a phase III, multi-centre, randomised controlled trial. Adults with tICH who were taking an OAC before injury will be recruited across approximately 20 trauma networks in the UK. Eligible participants will be randomised to restart DOAC therapy either 1 week or 4 weeks after tICH. The primary outcome is the proportion of patients with a haemorrhagic or thrombotic event within 12 weeks of tICH. Secondary outcomes include time-to-first haemorrhagic or thrombotic event, survival, functional status, quality of life and health resource use. Follow-up will occur at 6, 12 and 26 weeks, with data analysed on an intention-to-treat basis. Health economic and qualitative sub-studies will run alongside the main trial. Discussion This study addresses a major area of clinical uncertainty. By directly comparing 1-week versus 4-week re-initiation of OAC, this trial will provide robust evidence to guide clinical practice in a tICH population at high risk of both bleeding and thrombotic complications. Findings will inform patient counselling, acute care protocols and guideline development. Ethics and dissemination section Ethical approval has been obtained from the Berkshire Research Ethics Committee (24/SC/0298). Written informed consent will be obtained from all participants or their legal representatives before enrolment. Findings will be disseminated through peer-reviewed publications, scientific conferences, trial registry reporting and patient-facing summaries, with the aim of informing future guidance on anticoagulation management following tICrH. 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