ICH is the most feared, often lethal, complication of antithrombotic (anticoagulant and antiplatelet) therapy. Recent data indicate that about 50% of people with ICH are taking an 1174 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] antithrombotic agent at the time of ICH.330 In a recent hospital ICH cohort study, 25% of patients had AF.331 Risk of Ischemic Stroke: Survivors of ICH with AF are at risk of further brain ischemia but also recurrent ICH. The use of antithrombotic therapy (antiplatelet agents and anticoagulants) following ICH thus presents a major clinical dilemma. The risk of ischemic stroke with and without antithrombotic treatment must be weighed carefully against the possible increase in ICH risk associated with antithrombotic therapy. The risk of ischemic stroke in people with AF is typically estimated using instruments such as the CHA2DS2-VASC score, and it seems reasonable to use this score in populations of ICH survivors.332 Risk of Recurrent ICH: The future risk of ICH is highly variable; the annual recurrence risk was between 1.8% and 7.4% in one recent systematic review of observational CT is a highly sensitive test for ICH and can classify the location as lobar (originating in the lobes of the brain) or deep (originating in the basal ganglia or The risk of recurrence has been reported to be higher for lobar ICH than after deep ICH,333 a nding which is probably related to different underlying small vessel diseases that cause ICH in the different locations. Although CT can de ne ICH location, it cannot reliably identify the underlying type of causal small vessel disease. 