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The meta-analysis by D’Anna et al in this journal addresses an enduring and complex clinical dilemma: should oral anticoagulation (OAC) be prescribed in intracerebral haemorrhage (ICH) survivors with atrial fibrillation (AF)?1 The balance between reducing ischaemic stroke risk and the heightened risk of recurrent bleeding remains nuanced and unclear, generating persistent uncertainty in clinical decision-making. This dilemma presents itself for approximately 15 000 patients per year in the USA alone for what is otherwise a global challenge.2 As the population ages, so does the absolute number of patients with AF.