NOACs have an approximately 50% lower ICH risk than VKA124 and are therefore preferred in most ICH survivors, except where warfarin is indicated (eg, in those with metallic mechanical heart valves). Observational data suggest that ICH occurring on OAC are of similar size and with similar clinical outcome in patients taking VKA or NOACs.344 There are 2 ongoing randomized trials of antithrombotic use after ICH: APACHE-AF (http://apache-af.nl, aspirin vs apixaban vs no antithrombotics for the treatment of AF in patients after ICH) and Restart or Stop Antithrombotics Randomised Trial (RESTART) (www. restarttrial.org, antiplatelets vs no antiplatelets in patients with ICH with an indication for antiplatelets). LAA Occlusion in ICH Survivors: Randomized trials indicate that LAA occlusion (LAAO) has similar ef cacy to oral anticoagulation in patients with AF; thus, in ICH survivors with AF and high ischemic stroke risk, LAAO is a potentially attractive option to reduce ischemic stroke and systemic embolism from AF without the need to expose patients to a long-term risk of oral Observational data from 1,025 patients suggest that LAAO might be safe and effective in patients with a contraindication to long-term oral anticoagulation, but only a minority of patients (15%) in this study had suffered ICH.346 Small studies of ICH survivors suggest that LAAO, using antiplatelet treatment as periprocedural antithrombotic treatment, is safe and effective in this population, including those Randomized trials of LAAO, ideally in comparison to NOACs, are needed to de nitively determine the safety and ef cacy of each approach in ICH survivors. Recommendations 37. In patients with AF and high ischemic stroke risk, we suggest anticoagulation with an NOAC after acute spontaneous ICH (which includes subdural, subarachnoid, and intracerebral hemorrhages) after careful consideration of the risks and bene ts (Ungraded consensus-based statement). 