Management of anticoagulant-related intracranial hemorrhage: an evidence-based review

Ray, Bappaditya; Keyrouz, Salah

doi:10.1186/cc13889

Cited by 16 publications

(8 citation statements)

References 117 publications

(141 reference statements)

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“…Current guidelines therefore do not recommend its use for reversal of warfarin-related ICH. Additionally, it is 15 times more expensive than FFP and at least 3.5 times more expensive than PCC, and is associated with a higher risk of INR rebound [ 98 ]. In summary, patients with warfarin-related ICH and elevated INR should have vitamin K antagonist withheld, and should receive vitamin K (10 mg IV over 30 minutes) concomitantly with PCC guided by INR level or weighted-base dosing (20 UI/kg).…”

Section: Medical Management Of Ichmentioning

confidence: 99%

The critical care management of spontaneous intracranial hemorrhage: a contemporary review

et al. 2016

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Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding. The incidence of hypertension-related ICH is decreasing in some regions due to improvements in the treatment of chronic hypertension. Anticoagulant-related ICH (vitamin K antagonists and the newer oral anticoagulant drugs) represents an increasing cause of ICH, currently accounting for more than 15 % of all cases. Although questions regarding the optimal medical and surgical management of ICH still remain, recent clinical trials examining hemostatic therapy, blood pressure control, and hematoma evacuation have advanced our understanding of ICH management. Timely and aggressive management in the acute phase may mitigate secondary brain injury. The initial management should include: initial medical stabilization; rapid, accurate neuroimaging to establish the diagnosis and elucidate an etiology; standardized neurologic assessment to determine baseline severity; prevention of hematoma expansion (blood pressure management and reversal of coagulopathy); consideration of early surgical intervention; and prevention of secondary brain injury. This review aims to provide a clinical approach for the practicing clinician.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1432-0) contains supplementary material, which is available to authorized users.

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Section: Medical Management Of Ichmentioning

confidence: 99%

The critical care management of spontaneous intracranial hemorrhage: a contemporary review

et al. 2016

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“…An increased risk of anticoagulantassociated intracranial hemorrhage (AICH) was observed in patients with thromboembolic disease receiving anticoagulant therapy. Especially with warfarin, when the INR is between 2-4.5, the risk of AICH is 0.3 to 3.7% (Ray and Keyrouz, 2014). Due to the high risk of anticoagulation which can cause hematoma expansion and high morbidity due to warfarin-related intracerebral hemorrhage (WRICH), anticoagulation is recommended to be temporarily discontinued during the acute phase of ICH.…”

Section: Discussionmentioning

confidence: 99%

Myocardial bridging presenting as an acute coronary syndrome with mitral valve stenosis and paroxysmal atrial fibrillation: A case report

Kawilarang¹,

Rachmi²,

Azmi³

et al. 2021

IJRP

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We report a 33-year-old man presented to the emergency department with a chief complaint of typical angina three days before admission. An electrocardiogram showed arrowhead T-waves inversion in leads V1-V4, and the cardiac enzyme marker was increased. The initial diagnosis was non-ST-elevation acute coronary syndrome. On subsequent examinations, he had severe mitral stenosis, paroxysmal atrial fibrillation, and a history of intracranial hemorrhage. Diagnostic coronary angiography examination revealed myocardial bridging in the middle segment of left anterior descending coronary arteries. The patient was given dual antiplatelets (DAPT), beta-blocker, atorvastatin, and anticoagulant. Beta-blocker is the first-line therapy for myocardial bridging, whereas DAPT, anticoagulant, and high-dose statin therapy are used to treat acute coronary syndrome (ACS). The atherosclerotic process is commonly found in the proximal segment of myocardial bridging that can lead to ACS. In addition, mitral stenosis is one of the main causes of systemic embolism, including coronary embolism, while atrial fibrillation is known to increase the risk of embolism. Herein, we discuss the possible etiology of ACS, the management of myocardial bridging and comorbidity of this patient, and the rationale for selecting antithrombotic therapy.

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“…Whereas the RE-COVER trial, which compared dabigatran and warfarin in acute venous thromboembolism, reported no incidence of ICH during 6 months of therapy, ROCKET-AF reported that the ICH incidence was 0.49% for rivaroxaban compared to 0.74% for warfarin. 37 A recent prospective observational study reported that DOAC-ICH was associated with smaller ICH volume and better clinical outcome, when compared to warfarin-ICH. 38 However, these findings have not been confirmed by further observational studies.…”

Section: During Doacs Therapymentioning

confidence: 99%

Decision Algorithms for Direct Oral Anticoagulant Use in Patients With Nonvalvular Atrial Fibrillation: A Practical Guide for Neurologists

Canavero

Micieli

Paciaroni

2017

Clin Appl Thromb Hemost

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Direct oral anticoagulants (DOACs) are valid alternative options to vitamin K antagonists due to their limited interactions with drugs or food and the fact that they do not require regular coagulation monitoring. To this regard, recent practice guidelines recommend that DOACs should be considered as first-line anticoagulant therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). This review (1) outlines current international guidelines for the management of DOACs to prevent stroke in patients with NVAF, (2) outlines indications for elderly patients as well as specific settings including acute coronary syndromes and intracranial hemorrhage, and (3) offers a practical guide for the use of DOACs in neurological settings.

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Management of anticoagulant-related intracranial hemorrhage: an evidence-based review

Cited by 16 publications

References 117 publications

The critical care management of spontaneous intracranial hemorrhage: a contemporary review

The critical care management of spontaneous intracranial hemorrhage: a contemporary review

Myocardial bridging presenting as an acute coronary syndrome with mitral valve stenosis and paroxysmal atrial fibrillation: A case report

Decision Algorithms for Direct Oral Anticoagulant Use in Patients With Nonvalvular Atrial Fibrillation: A Practical Guide for Neurologists

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