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Management of anticoagulant-associated intracerebral hemorrhage
Date:8/1/2014

stroke. These diseases are found more frequently in older individuals, and the aging population keeps increasing. Consequently, the number of cases of anticoagulant-associated ICH (AAICH) is on the rise. Dr. LeRoux and colleagues cite a mortality rate for AAICH "as high as 42.3% to 67%"substantially higher than that of ICH as a whole. Such numbers indicate a great need to improve the treatment of AAICH.

"Race Against the clock" conveys the urgency involved in reversing the effect of anticoagulant medications in patients with ICH. In this educational supplement, Dr. Le Roux and colleagues have compiled up-to-date information on AAICH and its treatment. They offer a review of current oral anticoagulation therapies and describe various agents' mechanisms of action. Beginning with warfarin, the most well known and widely used anticoagulation agent, the authors move through newer oral anticoagulants such as the direct thrombin inhibitor dabigatran etexilate and the direct factor Xa inhibitors rivaroxaban and apixaban.

The authors review administration of vitamin K, fresh frozen plasma, prothrombin complex concentrates (both three-factor [used off label] and four-factor PCCs), and recombinant factor VIIa, as well as the use of dialysis, in reversing the effects of anticoagulants. Reversal of warfarin's effects has been widely tested, and the supplement offers a sample protocol for this. There are far fewer studies of reversal of the targeted oral anticoagulants (dabigatran etexilate, rivaroxaban, and apixaban), for which no specific antidotes have been identified as yet. The authors describe current and potential treatments used in cases of AAICH involving these agents.

The authors review the American Heart AssociationAmerican Stroke Association Guidelines for the management of spontaneous ICH. These AHA Guidelines include reversal strategies for AAICH but were written before the newer oral anticoagulants were approved for use. The authors po
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Contact: Jo Ann Eliason
jaeliason@thejns.org
434-982-1209
Journal of Neurosurgery Publishing Group
Source:Eurekalert

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