"In the first analysis of how to treat patients on anticoagulants who suffer a major bleeding event a clinical practice that routinely gives doctors pause while also evaluating a new drug University of Pittsburgh researchers aim to provide muchneeded guidance to clinicians trying to balance the risks of stroke versus bleeding when determining the best treatment.  The analysis published today in the journal Stroke determined that resuming anticoagulation therapy after a person suffers a major bleeding event was associated with a higher likelihood of strokefree survival than discontinuing anticoagulation. Furthermore restarting therapy with the new oral anticoagulant dabigatran was associated with a lower risk of recurrent hemorrhage in these cases than the old standby drug warfarin.  People take anticoagulants to avoid blood clots when they have a risk for stroke or heart attack but the downside is that these medications increase a persons risk of severe bleedingsuch as in the brain or gutbecause the blood isnt clotting as well as it otherwise might. If a patient who is on an anticoagulant to avoid a stroke has a major bleeding event doctors are faced with a catch Discontinue the anticoagulant to avoid future bleeding but again place their patient at increased risk of stroke or resume the anticoagulant to continue avoiding a stroke but then have to worry about another bleeding event said lead author Inmaculada Hernandez Pharm.D. Ph.D. an assistant professor in Pitts School of Pharmacy who completed this work as a doctoral student at Pitts Graduate School of Public Health.  It causes a lot of uncertainty for physicians especially because patients at highest risk of recurrent bleeding also are at highest risk of stroke said coauthor Yuting Zhang Ph.D. associate professor of health policy and management at Pitt Public Health and Hernandezs doctoral dissertation committee chair.  The Pitt research team obtained data from  to  for a random sample of Medicare beneficiaries. They then followed nearly  people who had filled prescriptions for the anticoagulants warfarin which has been used as a medication since  and dabigatran which was approved by the U.S. Food and Drug Administration in . More than  of those people suffered a major bleeding event while using one of the drugs. About half of those people resumed one of the two anticoagulants a few months after the bleeding while the others did not.  The risk of dying from any cause or having a stroke was  to  percent higher in patients who discontinued anticoagulation therapy compared to those who resumed it. People who took dabigatran after their initial bleeding event had nearly half the risk of another major bleeding event within one year compared with those who took warfarin.  Our results should encourage clinicians to seriously consider resuming anticoagulation among patients who survived a major bleeding event particularly if the source of bleeding was identified and addressed said senior author Samir Saba M.D. associate professor of medicine and associate chief of cardiology at UPMC Heart and Vascular Institute. They should also take into account that the benefittorisk ratio of posthemorrhage use of anticoagulation is not the same for all medications.  Additional authors on this research are Maria M. Brooks Ph.D. of Pitt Public Health and Paul K.L. Chin Ph.D. of the University of Otago in New Zealand.  This research was funded by the Commonwealth Foundation Agency for Healthcare Research and Quality grant R HS and National Institute of Mental Health grant R MH. Dr. Hernandez was supported by a fellowship from La Caixa foundation.  About the University of Pittsburgh Graduate School of Public Health  The University of Pittsburgh Graduate School of Public Health founded in  and now one of the topranked schools of public health in the United States conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases HIVAIDS cancer and other important public health problems. For more information about Pitt Public Health visit the schools Web site at http  http"