Emergency Reversal of Antithrombotics in Intracerebral Hemorrhage: An Update

PURPOSE OF REVIEW: Antithrombotic-associated intracerebral hemorrhage (ICH) is associated with high rates of morbidity and mortality. Rapid and effective antithrombotic reversal is critical for mitigating risk of hemorrhage expansion and neurological deterioration. This review provides an overview of the most recent advances in emergency antithrombotic reversal in ICH. RECENT FINDINGS: Rapid coagulopathy reversal within the first 60-90 min of hospital presentation may limit massive ICH expansion and improve outcomes. Current data suggests reversal of vitamin K antagonists with intravenous vitamin K and 4-factor prothrombin complex concentrates (4f-PCC), reversal of dabigatran with idarucizumab, and reversal or direct oral factor Xa inhibitors with either 4f-PCC or andexanet-alfa. While platelet transfusion is not suggested for antiplatelet-associated ICH, DDAVP may be reasonable, and a new reversal agent is under development for ticagrelor. Rapid reversal of antithrombotic-associated coagulopathy in the context of ICH may prevent ICH expansion and improve neurological outcomes.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

This update on emergency antithrombotic reversal in intracerebral hemorrhage covers vitamin K plus 4-factor PCC for vitamin K antagonists, idarucizumab for dabigatran, 4-factor PCC or andexanet-alfa for factor Xa inhibitors, and rapid reversal within 60-90 minutes of presentation.

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