Early reversal of oral anticoagulation and rapid blood pressure lowering are the primary therapeutic principles to prevent hematoma expansion in patients with oral anticoagulant-related intracerebral hemorrhage.
Rapid reversal of anticoagulation and strict blood pressure control are the mainstays of acute management for OAC-associated intracerebral hemorrhage to prevent hematoma expansion.
The incidence of intracerebral hemorrhage (ICH) associated with oral anticoagulants (OAC) is about one in five cases of ICH and associated with severe clinical presentation, frequently rapid clinical deterioration, and 30-days mortality of app 50%. This narrative review gives an overview of presentation and acute treatment of OAC-ICH. Oral anticoagulants do not cause ICH but lead to prolongation of bleeding and higher risk of hematoma expansion (HE). Clinicoradiological characteristics of oral anticoagulant associated ICH are not different from ICH in general. The therapeutic principle of reversal is to prevent or limit HE. The mode of action of the reversal agents for vitamin K antagonists, direct oral thrombin inhibitor and direct oral factor Xa inhibitors are described in the main text. We also discuss the principles of blood pressure lowering in the setting of acute OAC-ICH as it may be the second driving force of HE. Stroke unit care is needed to prevent further complications. Data from randomized controlled trials and observational data from unselected patients are needed to make stronger and more precise recommendations on acute therapy.
Christensen et al. (Tue,) conducted a review in Intracerebral hemorrhage related to oral anticoagulants. Oral anticoagulant reversal agents was evaluated. Early reversal of oral anticoagulation and rapid blood pressure lowering are the primary therapeutic principles to prevent hematoma expansion in patients with oral anticoagulant-related intracerebral hemorrhage.