Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage
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...
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2492-8 |
| _version_ | 1818258930899353600 |
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| author | Joji B. Kuramatsu Jochen A. Sembill Hagen B. Huttner |
| author_facet | Joji B. Kuramatsu Jochen A. Sembill Hagen B. Huttner |
| author_sort | Joji B. Kuramatsu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-12T18:07:22Z |
| format | Article |
| id | doaj.art-b093a049edd04829ac8197cd6ebe4460 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-12T18:07:22Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-b093a049edd04829ac8197cd6ebe44602022-12-22T00:16:27ZengBMCCritical Care1364-85352019-06-012311910.1186/s13054-019-2492-8Reversal of oral anticoagulation in patients with acute intracerebral hemorrhageJoji B. Kuramatsu0Jochen A. Sembill1Hagen B. Huttner2Department of Neurology, University Hospital ErlangenDepartment of Neurology, University Hospital ErlangenDepartment of Neurology, University Hospital ErlangenAbstract 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.http://link.springer.com/article/10.1186/s13054-019-2492-8Intracerebral hemorrhageAnticoagulation reversalTranexamic acidCiraparantagDesmopressin |
| spellingShingle | Joji B. Kuramatsu Jochen A. Sembill Hagen B. Huttner Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage Critical Care Intracerebral hemorrhage Anticoagulation reversal Tranexamic acid Ciraparantag Desmopressin |
| title | Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage |
| title_full | Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage |
| title_fullStr | Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage |
| title_full_unstemmed | Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage |
| title_short | Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage |
| title_sort | reversal of oral anticoagulation in patients with acute intracerebral hemorrhage |
| topic | Intracerebral hemorrhage Anticoagulation reversal Tranexamic acid Ciraparantag Desmopressin |
| url | http://link.springer.com/article/10.1186/s13054-019-2492-8 |
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