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The science and art of medicine intersect when it is necessary to balance the potential benefits and risks of a therapeutic intervention for which there are limited or no applicable data from properly conducted randomized controlled trials. In this issue of Neurology, Viswanathan et al.1 focus on the dilemma physicians face when caring for patients who have a risk of ischemic cerebro- or cardiovascular events that might be reduced with antithrombotic drugs, but also have a risk of parenchymal intracerebral bleeding because of a previous hemorrhage. The risk of ischemic events is low with short-term cessation of anticoagulation in patients with intracranial bleeding who are at high risk of cardiogenic embolism because of mechanical heart valves or atrial fibrillation.2,3 However, there are also reports indicating few adverse consequences from continuing anticoagulants in patients who have had an intracerebral hemorrhage.4,5 Despite these reports, physicians commonly discontinue anticoagulants …
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