The study protocol for the RELACS trial (Restarting Anticoagulation Early versus Late) has now been published in Trials:
RELACS is a Phase III, international, multicenter, assessor-blinded randomized controlled trial that investigates the safety and efficacy of early versus late resumption of oral anticoagulation in patients with chronic subdural hematoma and atrial fibrillation. The trial is led by Rahul Raj and colleagues at Helsinki University Hospital, with local principal investigators in Tampere (Teemu Luoto), Turku (Jussi Posti), Oulu (Oula A. Knuutinen), Kuopio (Nils Danner) and Stockholm (Jiri Bartek).
Surgery for chronic subdural hematoma has rapidly become most common emergency neurosurgical procedure worldwide, with up to 20–25% of patients being on oral anticoagulation medication due to atrial fibrillation. Yet the optimal management of anticoagulation remains a major controversy and is a daily clinical dilemma that requires balancing the risks of thromboembolic events against recurrent hemorrhage.
RELACS follows the legacy of the high-quality pragmatical FINISH trial, with the aim to provide the first evidence-based guidelines for this growing patient population. The study represents a robust collaborative effort, involving all five university neurosurgical departments in Finland, Karolinska University Hospital in Sweden and FICEBO.
Recruitment for RELACS officially began in Helsinki July 2025, with the other centers starting to recruit during the fall of 2025. With the protocol now published and the trial actively enrolling patients, we are pleased to lead this important effort to resolve a daily challenge in neurosurgical care.
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