Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jun 6;23(1):206.
doi: 10.1186/s13054-019-2492-8.

Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage

Joji B Kuramatsu  1 , Jochen A Sembill  2 , Hagen B Huttner  2
Affiliations
Review

Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage

Joji B Kuramatsu et al. Crit Care. .

Abstract

In light of an aging population with increased cardiovascular comorbidity, the use of oral anticoagulation (OAC) is steadily expanding. A variety of pharmacological alternatives to vitamin K antagonists (VKA) have emerged over recent years (direct oral anticoagulants, DOAC, i.e., dabigatran, rivaroxaban, apixaban, and edoxaban) which show a reduced risk for the occurrence of intracerebral hemorrhage (ICH). Yet, in the event of ICH under OAC (OAC-ICH), hematoma characteristics are similarly severe and clinical outcomes likewise substantially limited in both patients with VKA- and DOAC-ICH, which is why optimal acute hemostatic treatment in all OAC-ICH needs to be guaranteed. Currently, International Guidelines for the hemostatic management of patients with OAC-ICH are updated as several relevant large-sized observational studies and recent trials have established treatment approaches for both VKA- and DOAC-ICH. While the management of VKA-ICH is mainly based on the immediate reversal of elevated levels of international normalized ratio using prothrombin complex concentrates, hemostatic management of DOAC-associated ICH is challenging requiring specific antidotes, notably idarucizumab and andexanet alfa. This review will provide an overview of the latest studies and trials on hemostatic reversal agents and timing and summarizes the effects on hemorrhage progression and clinical outcomes in patients with OAC-ICH.

Keywords: Anticoagulation reversal; Ciraparantag; Desmopressin; Intracerebral hemorrhage; Tranexamic acid.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Acute management of anticoagulation-associated intracerebral hemorrhage. Listed values vary according to renal function and drug interactions. Consult product characteristics for individual decision making. h, hours; ICH, intracerebral hemorrhage; IV, intravenous; DOAC, direct oral anticoagulants; PCC, prothrombin complex concentrate; VKA, vitamin K antagonist. FEIBA, activated 4-factor PCC; IU, international units; kg, kilogram; BW, body weight
See this image and copyright information in PMC

Comment in

References

    1. Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259–e281. - PMC - PubMed
    1. Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009;40(2):394–399. - PubMed
    1. Hemphill JC, 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–2060. - PubMed
    1. Sembill JA, Gerner ST, Volbers B, Bobinger T, Lucking H, Kloska SP, et al. Severity assessment in maximally treated ICH patients: the max-ICH score. Neurology. 2017;89(5):423–431. - PubMed
    1. Baharoglu MI, Cordonnier C, Salman RA, de Gans K, Koopman MM, Brand A, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016;387(10038):2605–2613. - PubMed

MeSH terms