The role of anticoagulants, antiplatelet agents, and their reversal strategies in the management of intracerebral hemorrhage

James, Robert F.; Palys, Viktoras; Lomboy, Jason; Lamm, John Richard; Simon, Scott D.

doi:10.3171/2013.2.focus1328

Cited by 28 publications

(13 citation statements)

References 77 publications

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“…Historical reversal strategies (e.g. vitamin K and fresh frozen plasma) are slow and have little impact on the effect of NOACs [15]. Several authors have demonstrated the successful use of emergent hemodialysis in patients on dabigatran.…”

Section: Resultsmentioning

confidence: 98%

Spontaneous cerebellar hemorrhage in a patient taking apixaban

Shank

Dupépé

Sands

et al. 2015

Interdisciplinary Neurosurgery

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a b s t r a c tObjectives: Atrial fibrillation is closely associated with cardioembolic stroke. Until recently, warfarin has been the gold standard for the treatment of atrial fibrillation. Since 2010 the United States Food and Drug Administration has approved three new agents for anticoagulation in patients with atrial fibrillation. The purpose of this case report is to discuss some of the practical implications for using these agents. Methods: A patient taking apixaban presented with a spontaneous cerebellar hemorrhage. While the patient was initially considered a candidate for surgical intervention, the lack of literature addressing surgical intervention in patients on novel anticoagulation clouded the clinical decision-making. The patient was ultimately managed with administration of activated prothrombin complex concentrate, blood pressure control, frequent clinical assessments and airway protection. The patient did not undergo craniotomy for hematoma evacuation. Conclusions: Recent FDA approval of several novel oral anticoagulants for use in patients with atrial fibrillation has resulted in a significant number of patients formerly treated with warfarin being switched to these newer agents. There remains a lack of clear guidelines for the management of hemorrhagic complications. This case report describes one management strategy and highlights the paucity of current evidence to support critical clinical decisions.

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Section: Resultsmentioning

confidence: 98%

Spontaneous cerebellar hemorrhage in a patient taking apixaban

Shank

Dupépé

Sands

et al. 2015

Interdisciplinary Neurosurgery

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“…Currently, there are no reversal agents for aspirin and clopidogrel, although to reverse platelet dysfunction, desmopressin acetate may be helpful. Platelet transfusion may also be of some benefit in restoring functional platelets to patients …”

Section: Reversal Of Anticoagulationmentioning

confidence: 99%

AHNS Series: Do you know your guidelines? Perioperative antithrombotic management in head and neck surgery

2017

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Head and neck surgeons are commonly faced with surgical patients who have underlying medical problems requiring antithrombotic therapy. It is difficult to achieve a balance between minimizing the risk of thromboembolism and hemorrhage in the perioperative period. Data from randomized, controlled trials are limited, and procedurespecific bleed rates are also difficult to pinpoint. The decision is made more difficult when patients with moderate-to-high risk for thromboembolic events undergo procedures that are high risk for bleeding. This is true for many head and neck oncologic surgeries. Furthermore, although elective procedures may be delayed for optimization of antithrombotic medication, emergent procedures cannot. Head and neck surgery often represents the most challenging of all these circumstances, given the potential risk of airway compromise from bleeding after head and neck surgery. K E Y W O R D Santicoagulants, antithrombotics, guidelines, head and neck cancer, perioperative | I NT ROD UCTI ONOpinions can differ among medical specialists, surgeons, and anesthesiologists regarding perioperative antithrombotic management. The purpose of this article is to review contemporary guidelines, based on the available literature, for management of antithrombotic medications in the perioperative period specific to head and neck oncologic surgery. Although general guidelines are helpful, it should be stressed that clear lines of communication among providers are essential to achieve a "right balance," especially in cases that do not fit neatly within existing guidelines.

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“…The use of antiplatelet agents has been shown to increase bleeding risks after surgery and trauma and to increase the risk of spontaneous and post-traumatic intracranial bleeding. 10 11 However, assessing this risk is dependent on actual platelet function. Platelet counts alone demonstrate limited correlation with bleeding risk.…”

Section: Antiplatelet Agentsmentioning

confidence: 99%

“…The indications for providing agents to restore platelet function in the setting of bleeding risk are controversial. 10–12 For ASA-induced platelet dysfunction, intravenous desmopressin has been shown to restore activity, though little clinical outcome data are available. 10 13 The indications for the use of platelet transfusion to reverse the antiplatelet activity of clopidogrel and ASA have not been established and clinical data are variable.…”

Section: Antiplatelet Agentsmentioning

confidence: 99%

Surgeon's guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation

Yeung

Sarani

Weinberg

et al. 2016

Trauma Surg Acute Care Open

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An increasing number of potent antiplatelet and anticoagulant medications are being used for the long-term management of cardiac, cerebrovascular, and peripheral vascular conditions. Management of these medications in the perioperative and peri-injury settings can be challenging for surgeons, mandating an understanding of these agents and the risks and benefits of various management strategies. In this two part review, agents commonly encountered by surgeons in the perioperative and peri-injury settings are discussed and management strategies for patients on long-term antiplatelet and anticoagulant therapy reviewed. In part one, we review warfarin and the new direct oral anticoagulants. In part two, we review antiplatelet agents and assessment of platelet function and the perioperative management of long-term anticoagulation and antiplatelet therapy.

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The role of anticoagulants, antiplatelet agents, and their reversal strategies in the management of intracerebral hemorrhage

Cited by 28 publications

References 77 publications

Spontaneous cerebellar hemorrhage in a patient taking apixaban

Spontaneous cerebellar hemorrhage in a patient taking apixaban

AHNS Series: Do you know your guidelines? Perioperative antithrombotic management in head and neck surgery

Surgeon's guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation

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