Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

Frontera, Jennifer A.; Lewin, John J.; Rabinstein, Alejandro A.; Aisiku, Imo; Alexandrov, Anne W.; Cook, Aaron M.; Zoppo, Gregory J. del; Kumar, Monisha A.; Peerschke, Ellinor I.B.; Stiefel, Michael F.; Teitelbaum, Jeanne; Wartenberg, Katja E.; Zerfoss, Cindy

doi:10.1007/s12028-015-0222-x

Cited by 582 publications

(250 citation statements)

References 416 publications

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“…Current NCS guidelines recommend using activated charcoal and PCC if needed for direct factor Xa inhibitor-related ICH. They recommend use of Idarucizumab for dabigatran-related ICH, which is supported by animal and current human studies (131). …”

Section: Hematoma Expansionmentioning

confidence: 94%

“…The clinical benefit would have to outweigh the side effect of arterial thrombosis and the right dose and clinical setting would need to be narrowly defined. Currently, AHA/ASA and neurocritical care society (NCS) guidelines recommend against use of rFVIIa in ICH patients (1, 131). …”

Section: Hematoma Expansionmentioning

confidence: 99%

“…A RCT of PCC versus FFP in ICH patients is currently recruiting patients (139). Supporting animal studies and phase-III studies have led to NCS recommendations of administering PCC with intravenous vitamin K over FFP and vitamin K combination for warfarin reversal for ICH patients (131). …”

Section: Hematoma Expansionmentioning

confidence: 99%

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Intracerebral Hemorrhage: Perihemorrhagic Edema and Secondary Hematoma Expansion: From Bench Work to Ongoing Controversies

Mittal

LacKamp

2016

Front. Neurol.

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Intracerebral hemorrhage (ICH) is a medical emergency, which often leads to severe disability and death. ICH-related poor outcomes are due to primary injury causing structural damage and mass effect and secondary injury in the perihemorrhagic region over several days to weeks. Secondary injury after ICH can be due to hematoma expansion (HE) or a consequence of repair pathway along the continuum of neuroinflammation, neuronal death, and perihemorrhagic edema (PHE). This review article is focused on PHE and HE and will cover the animal studies, related human studies, and clinical trials relating to these mechanisms of secondary brain injury in ICH patients.

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Section: Hematoma Expansionmentioning

confidence: 94%

Section: Hematoma Expansionmentioning

confidence: 99%

See 1 more Smart Citation

Intracerebral Hemorrhage: Perihemorrhagic Edema and Secondary Hematoma Expansion: From Bench Work to Ongoing Controversies

Mittal

LacKamp

2016

Front. Neurol.

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“…Of note, in a retrospective study of 18 TBI patients with either ICH or subarachnoid hemorrhage who were taking either rivaroxaban or apixaban, 4-factor prothrombin complex concentrate was safely used to potentially reduce hematoma expansion [36]. The Neurocritical Care Society (NCS) has recently released guidelines for the rapid reversal of antithrombotics in ICH [37], the principles of which may serve as a guide for sTBI management as well.…”

Section: Emergency Department Considerationsmentioning

confidence: 99%

Medical Management of the Severe Traumatic Brain Injury Patient

et al. 2017

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Severe traumatic brain injury (sTBI) is a major contributor to long term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with pre-hospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of severe TBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care. Where appropriate, differences between the third and fourth editions of the Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury are highlighted.

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“…These include general-use agents, such as four-factor prothrombin complex concentrates (72) (trade name Kcentra, approved for use in the United States in 2013), and targeted drugs, such as the antibody idarucizumab (trade name Praxibind, approved for use in the United States in 2015), which inactivates dabigatran (73). As a result, although guidelines exist for the reversal of anticoagulation in SICH, the majority of these are good-practice recommendations without extensive, high-quality supporting evidence (74). …”

Section: Translational Therapiesmentioning

confidence: 99%

Targeting Secondary Hematoma Expansion in Spontaneous Intracerebral Hemorrhage – State of the Art

Guan

Hawryluk

2016

Front. Neurol.

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Spontaneous intracerebral hemorrhage (SICH), defined broadly as intracerebral hemorrhage not related to trauma, results in long-term disability or death in a large proportion of afflicted patients. Current management of this disease is predominantly supportive, including airway protection, optimization of hemodynamic parameters, and management of intracranial pressure. No active treatments that demonstrate beneficial effects on clinical outcome are currently available. Animal models of SICH have allowed for the elucidation of multiple pathways that may be attractive therapeutic targets. A minority of these, such as aggressive blood pressure management and recombinant activated factor VII administration, have led to large-scale clinical trials. There remains a critical need for further translational research in the realm of SICH.

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Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

Abstract: This guideline provides timely, evidence-based reversal strategies to assist practitioners in the care of patients with antithrombotic-associated intracranial hemorrhage.

Cited by 582 publications

References 416 publications

Intracerebral Hemorrhage: Perihemorrhagic Edema and Secondary Hematoma Expansion: From Bench Work to Ongoing Controversies

Intracerebral Hemorrhage: Perihemorrhagic Edema and Secondary Hematoma Expansion: From Bench Work to Ongoing Controversies

Medical Management of the Severe Traumatic Brain Injury Patient

Targeting Secondary Hematoma Expansion in Spontaneous Intracerebral Hemorrhage – State of the Art

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