Treatment of intracerebral hemorrhage associated with new oral anticoagulant use: the neurologist's view

Roland Veltkamp; Solveig Horstmann

doi:10.1016/j.cll.2014.06.007

Treatment of intracerebral hemorrhage associated with new oral anticoagulant use: the neurologist's view

Clin Lab Med. 2014 Sep;34(3):587-94. doi: 10.1016/j.cll.2014.06.007. Epub 2014 Jul 29.

Authors

Roland Veltkamp¹, Solveig Horstmann²

Affiliations

¹ Department of Stroke Medicine, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London W6 8RF, UK; Department of Neurology, University of Heidelberg, INF 400, Heidelberg 69120, Germany. Electronic address: [email protected].
² Department of Neurology, University of Heidelberg, INF 400, Heidelberg 69120, Germany.

PMID: 25168944
DOI: 10.1016/j.cll.2014.06.007

Abstract

Intracerebral hemorrhage (ICH) associated with the use of oral anticoagulants (OAC-ICH) results in particularly severe strokes. A key target for the treatment of OAC-ICH is rapid restoration of effective coagulation. In patients receiving vitamin K antagonists, hemostatic factors such as prothrombin complex concentrate (PCC), fresh frozen plasma, and recombinant activated factor VII, in addition to vitamin K, can be used for anticoagulation reversal. However, emergency management of ICH during treatment with the new direct OACs (NOACs) is a major challenge. In the absence of specific antidotes, PCCs are recommended for NOAC reversal, mainly based on preclinical data.

Keywords: Intracerebral hemorrhage; New oral anticoagulants; Oral anticoagulation; Warfarin.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Administration, Oral
Animals
Anticoagulants / administration & dosage
Anticoagulants / adverse effects*
Cerebral Hemorrhage / chemically induced*
Cerebral Hemorrhage / epidemiology
Cerebral Hemorrhage / mortality
Cerebral Hemorrhage / therapy*
Cerebrovascular Circulation / drug effects*
Evidence-Based Medicine*
Humans
Risk Factors

Substances

Anticoagulants