Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine

Jennifer A. Frontera, John J. Lewin, Alejandro A. Rabinstein, Imo P. Aisiku, Anne W. Alexandrov, Aaron M. Cook, Gregory J. del Zoppo, Monisha A. Kumar, Ellinor I.B. Peerschke, Michael F. Stiefel, Jeanne S. Teitelbaum, Katja E. Wartenberg, Cindy L. Zerfoss

Research output: Contribution to journalArticle

264 Scopus citations

Abstract

Background: The use of antithrombotic agents, including anticoagulants, antiplatelet agents, and thrombolytics has increased over the last decade and is expected to continue to rise. Although antithrombotic-associated intracranial hemorrhage can be devastating, rapid reversal of coagulopathy may help limit hematoma expansion and improve outcomes. Methods: The Neurocritical Care Society, in conjunction with the Society of Critical Care Medicine, organized an international, multi-institutional committee with expertise in neurocritical care, neurology, neurosurgery, stroke, hematology, hemato-pathology, emergency medicine, pharmacy, nursing, and guideline development to evaluate the literature and develop an evidence-based practice guideline. Formalized literature searches were conducted, and studies meeting the criteria established by the committee were evaluated. Results: Utilizing the GRADE methodology, the committee developed recommendations for reversal of vitamin K antagonists, direct factor Xa antagonists, direct thrombin inhibitors, unfractionated heparin, low-molecular weight heparin, heparinoids, pentasaccharides, thrombolytics, and antiplatelet agents in the setting of intracranial hemorrhage. Conclusions: This guideline provides timely, evidence-based reversal strategies to assist practitioners in the care of patients with antithrombotic-associated intracranial hemorrhage.

Original languageEnglish (US)
Pages (from-to)6-46
Number of pages41
JournalNeurocritical care
Volume24
Issue number1
DOIs
StatePublished - Feb 1 2016

Keywords

  • Activated prothrombin complex concentrates
  • Alteplase
  • Anticoagulant
  • Antidote
  • Antiplatelet
  • Antithrombotic
  • Apixaban
  • Aspirin
  • Clopidogrel
  • Coumadin
  • Cryoprecipitate
  • DDAVP
  • DTI
  • Dabigatran
  • Desmopressin
  • Direct thrombin inhibitor
  • Edoxaban
  • FEIBA
  • FFP
  • Factor Xa inhibitor
  • Fondaparinux
  • Fresh frozen plasma
  • GRADE criteria
  • Guideline
  • Heparin
  • Heparinoid
  • ICH
  • Intracerebral hemorrhage
  • Intracranial hemorrhage
  • Intraparenchymal hemorrhage
  • Low-molecular weight heparin
  • PCC
  • Pentasaccharide
  • Plasminogen activator
  • Platelets
  • Protamine
  • Prothrombin complex concentrates
  • Recombinant factor VIIa
  • Reversal
  • Rivaroxaban
  • SAH
  • SDH
  • Subarachnoid hemorrhage
  • Subdural hematoma
  • TPA
  • Thrombolytic
  • VKA
  • Vitamin K antagonist
  • Warfarin
  • aPCC
  • rFVIIa
  • rtPA

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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    Frontera, J. A., Lewin, J. J., Rabinstein, A. A., Aisiku, I. P., Alexandrov, A. W., Cook, A. M., del Zoppo, G. J., Kumar, M. A., Peerschke, E. I. B., Stiefel, M. F., Teitelbaum, J. S., Wartenberg, K. E., & Zerfoss, C. L. (2016). Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocritical care, 24(1), 6-46. https://doi.org/10.1007/s12028-015-0222-x