학술논문

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine
Document Type
Original Paper
Source
Neurocritical Care. February 2016 24(1):6-46
Subject
Anticoagulant
Antiplatelet
Antithrombotic
Intracranial hemorrhage
Intracerebral hemorrhage
Intraparenchymal hemorrhage
ICH
Subarachnoid hemorrhage
SAH
Subdural hematoma
SDH
Reversal
Antidote
Vitamin K antagonist
VKA
Warfarin
Coumadin
Direct thrombin inhibitor
DTI
Dabigatran
Factor Xa inhibitor
Apixaban
Rivaroxaban
Edoxaban
Low-molecular weight heparin
Heparin
Heparinoid
Pentasaccharide
Fondaparinux
TPA
rtPA
Alteplase
Thrombolytic
Plasminogen activator
Aspirin
Clopidogrel
Prothrombin complex concentrates
PCC
aPCC
FEIBA
Activated prothrombin complex concentrates
FFP
Fresh frozen plasma
Recombinant factor VIIa
rFVIIa
Protamine
Platelets
DDAVP
Desmopressin
Cryoprecipitate
Guideline
GRADE criteria
Language
English
ISSN
1541-6933
1556-0961
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.