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

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

doi:10.1097/ccm.0000000000002057

Cited by 130 publications

(142 citation statements)

References 12 publications

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“…While the use of antifibrinolytic agents is recommended when cryoprecipitate cannot be administered within a reasonable timeframe, the role of concurrent antifibrinolytic agents or platelet transfusions with fibrinogen products remains unclear. 8 In addition to rt-PA induced coagulopathy, reperfusion of ischemic vasculature and damage to the blood brain barrier secondary to activation of matrix metalloproteinases in the setting of ischemia may also play a role in the risk for ICH after rt-PA administration. 26 While there is much to be discovered in the pathophysiology of hemorrhagic complications following rt-PA administration, utilization of products containing fibrinogen has become standard practice.…”

Section: Discussionmentioning

confidence: 99%

Fibrinogen Concentrate for the Treatment of Thrombolysis-Associated Hemorrhage in Adult Ischemic Stroke Patients

Barra

Feske

Sylvester

et al. 2020

Clin Appl Thromb Hemost

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In patients with ischemic stroke who receive systemic recombinant tissue plasminogen activator (rt-PA), the risk of secondary hemorrhage is 1-7%. Fibrinogen supplementation with cryoprecipitate is recommended in patients with rt-PA-associated symptomatic hemorrhage. We examined whether fibrinogen concentrate can be used safely in this setting. A single-center retrospective case series was performed in patients who received fibrinogen concentrate for post-rt-PA hemorrhage between January-2012 and December-2017. The primary outcome was the incidence of in-hospital thromboembolic events and infusion reactions. Secondary outcomes included incidence of clinically significant ICH expansion within 24-hours and patient serum fibrinogen response to fibrinogen concentrate therapy. Thromboembolic events occurred in 3 (12.5%) of 24 patients included in the analysis. No patients experienced infusion-related reactions. Five of 22 patients with ICH experienced clinically significant hemorrhage expansion. Hypofibrinogenemia was corrected in 87.5%(7/8) of patients with baseline hypofibrinogenemia, with a median increase in serum fibrinogen 166 mg/dL. Median fibrinogen increase in patients without baseline hypofibrinogenemia was 18 mg/dL. Fibrinogen concentrate is a safe potential therapeutic option to restore fibrinogen levels in acute ischemic stroke patients with thrombolysis-associated hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Fibrinogen Concentrate for the Treatment of Thrombolysis-Associated Hemorrhage in Adult Ischemic Stroke Patients

Barra

Feske

Sylvester

et al. 2020

Clin Appl Thromb Hemost

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“…40 This is supported by the British Committee for Standards Head injury in the elderly in Haematology, which states that following head-injury admission anticoagulated patients are likely to require a CT scan, need their international normalised ratio (INR) measured, and if head injury is strongly suspected reversal of the INR with PCC. 41 The use of recombinant factor VIIa or fresh frozen plasma is not acceptable management. 42 Further measures should include 5-10mg of intravenous vitamin K, immediate cessation of all anticoagulant therapy and serial measurement of INR at 30 minutes, 4-6 hours and 24 hours in case further doses of PCC are required.…”

Section: Reversal Of Anticoagulantsmentioning

confidence: 99%

Head injury in the elderly – an overview for the physician

et al. 2019

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Head injury is a common cause for hospital admission and additionally 250,000 UK inpatients fall during hospital admissions annually. Head injury most commonly occurs as a result of falls from standing height in older adults. Older adults are frequently frail and multi-morbid; many have indications for anticoagulation and antiplatelet agents. The haemorrhagic complications of head injury occur in up to 16% of anticoagulated patients sustaining a head injury. These patients suffer adverse outcomes from surgery as a result of medical complications. Although geriatric trauma models are evolving to meet the demand of an ageing trauma population, medical support to trauma services is commonly delivered by general physicians, many of whom lack experience and training in this fi eld. Determining the role of surgery and interrupted anticoagulation requires careful personalised risk assessment. Appreciation of the opposing risks can be challenging; it requires an understanding of the evidence base in both surgery and medicine to rationalise decision making and inform communication. This article aims to provide an overview for the physician with clinical responsibility for patients who have sustained head injury.

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“…Appropriate reversal of coagulopathy is essential medical management to improve ASDH. 28 99) Warfarin such as vitamin K antagonist is typical anticoagulation agent and patients who take warfarin should take 10 mg vitamin K bolus with 4-factor prothrombin complex concentrate 25–50 µ/kg(depend on international normalized ratio). 32) Recombinant factor VIIa and fresh frozen plasma is useful antidote of warfarin in emergent ASDH situation.…”

Section: Critical Care Of Asdhmentioning

confidence: 99%

Neurocritical Management of Traumatic Acute Subdural Hematomas

Shin

Hwang

2020

Korean J Neurotrauma

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Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury. Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate. However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.

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

Cited by 130 publications

References 12 publications

Fibrinogen Concentrate for the Treatment of Thrombolysis-Associated Hemorrhage in Adult Ischemic Stroke Patients

Fibrinogen Concentrate for the Treatment of Thrombolysis-Associated Hemorrhage in Adult Ischemic Stroke Patients

Head injury in the elderly – an overview for the physician

Neurocritical Management of Traumatic Acute Subdural Hematomas

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