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 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

171 Citations (Scopus)

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

Fingerprint

Intracranial Hemorrhages
Fibrinolytic Agents
Platelet Aggregation Inhibitors
Guidelines
Delivery of Health Care
Heparinoids
Factor Xa
Antithrombins
Vitamin K
Emergency Medicine
Evidence-Based Practice
Low Molecular Weight Heparin
Neurosurgery
Hematology
Neurology
Practice Guidelines
Hematoma
Anticoagulants
Heparin
Patient Care

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage : A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. / Frontera, Jennifer A.; Lewin, John J.; Rabinstein, Alejandro A.; Aisiku, Imo P.; Alexandrov, Anne; Cook, Aaron M.; del Zoppo, Gregory J.; Kumar, Monisha A.; Peerschke, Ellinor I.B.; Stiefel, Michael F.; Teitelbaum, Jeanne S.; Wartenberg, Katja E.; Zerfoss, Cindy L.

In: Neurocritical Care, Vol. 24, No. 1, 01.02.2016, p. 6-46.

Research output: Contribution to journalArticle

Frontera, JA, Lewin, JJ, Rabinstein, AA, Aisiku, IP, Alexandrov, A, Cook, AM, del Zoppo, GJ, Kumar, MA, Peerschke, EIB, Stiefel, MF, Teitelbaum, JS, Wartenberg, KE & Zerfoss, CL 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, vol. 24, no. 1, pp. 6-46. https://doi.org/10.1007/s12028-015-0222-x
Frontera, Jennifer A. ; Lewin, John J. ; Rabinstein, Alejandro A. ; Aisiku, Imo P. ; Alexandrov, Anne ; Cook, Aaron M. ; del Zoppo, Gregory J. ; Kumar, Monisha A. ; Peerschke, Ellinor I.B. ; Stiefel, Michael F. ; Teitelbaum, Jeanne S. ; Wartenberg, Katja E. ; Zerfoss, Cindy L. / Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage : A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. In: Neurocritical Care. 2016 ; Vol. 24, No. 1. pp. 6-46.
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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.",
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AU - Alexandrov, Anne

AU - Cook, Aaron M.

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AU - Stiefel, Michael F.

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