Principles of reversal of anticoagulation in patients with intracerebral hemorrhage related to oral anticoagulants
(2025) In European Stroke Journal 10(1_suppl). p.4-13- Abstract
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... (More)
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.
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- author
- Christensen, Hanne ; Casolla, Barbara ; Frontera, Jennifer A. ; Grundtvig, Josefine ; Nielsen, Jørn Dalsgaard LU ; Petersson, Jesper LU and Steiner, Thorsten
- organization
- publishing date
- 2025-04
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- direct oral anticoagulants, Intracerebral hemorrhage, oral anticoagulants, reversal, vitamin K antagonists
- in
- European Stroke Journal
- volume
- 10
- issue
- 1_suppl
- pages
- 10 pages
- publisher
- SAGE Publications
- external identifiers
-
- pmid:40401657
- scopus:105006516444
- ISSN
- 2396-9873
- DOI
- 10.1177/23969873231222393
- language
- English
- LU publication?
- yes
- id
- 12a1997b-90d5-4823-a2e2-4c06eeb5125c
- date added to LUP
- 2025-08-12 14:46:22
- date last changed
- 2025-08-13 03:00:03
@article{12a1997b-90d5-4823-a2e2-4c06eeb5125c,
abstract = {{<p>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.</p>}},
author = {{Christensen, Hanne and Casolla, Barbara and Frontera, Jennifer A. and Grundtvig, Josefine and Nielsen, Jørn Dalsgaard and Petersson, Jesper and Steiner, Thorsten}},
issn = {{2396-9873}},
keywords = {{direct oral anticoagulants; Intracerebral hemorrhage; oral anticoagulants; reversal; vitamin K antagonists}},
language = {{eng}},
number = {{1_suppl}},
pages = {{4--13}},
publisher = {{SAGE Publications}},
series = {{European Stroke Journal}},
title = {{Principles of reversal of anticoagulation in patients with intracerebral hemorrhage related to oral anticoagulants}},
url = {{http://dx.doi.org/10.1177/23969873231222393}},
doi = {{10.1177/23969873231222393}},
volume = {{10}},
year = {{2025}},
}