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Neurocritical Care
Published in: Neurocritical Care 1/2016

01-02-2016 | Review Article

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine

Authors: Jennifer A. Frontera, John J. Lewin III, 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

Published in: Neurocritical Care | Issue 1/2016

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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.
Appendix
Available only for authorised users
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Metadata
Title
Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage
A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine
Authors
Jennifer A. Frontera
John J. Lewin III
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
Publication date
01-02-2016
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0222-x

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