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Antithrombotic- and Thrombolytic-Related Intracerebral Hemorrhage

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Intracerebral Hemorrhage Therapeutics

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Abstract

Intracerebral hemorrhage related to anticoagulant therapy represents a neurologic emergency. This chapter reviews the evidence of anticoagulation reversal treatment and further elucidates management of intracerebral hemorrhage occurring in relation to antithrombotic treatment and thrombolysis, as well as heparin. Prothrombin concentrate can effectively reverse vitamin K antagonist therapy and should be immediately administered in acute intracerebral hemorrhage associated with vitamin K antagonist therapy. For non-vitamin K antagonist-associated intracerebral hemorrhage, recent observational data show a similar rate of hematoma expansion than with vitamin K antagonists. Specific antidotes for non-vitamin K antagonist reversal are either available (idarucizumab for reversal of dabigatran) or in development (for factor Xa inhibitors). Importantly, in case of intracerebral hemorrhage associated with antiplatelet therapy, cessation of antiplatelet therapy seems sufficient in most cases, and platelet infusions should not be given. Despite all recent advances, anticoagulation-related intracerebral hemorrhage still is associated with unfavorable clinical outcome and further efforts need to be taken to define the optimal medical management.

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Author information

Authors and Affiliations

  1. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany

    Jan C. Purrucker & Thorsten Steiner

  2. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Academic Health Center, Cincinnati, OH, USA

    Matthew L. Flaherty

  3. Department of Neurology, Texas Tech University, El Paso, TX, USA

    Gustavo Rodriguez

  4. Departments of Neurology and Neuro-critical Care, University of Pennsylvania, Philadelphia, PA, USA

    Saqib Chaudhry

  5. Department of Neurology, Southern Illinois University, Springfield, IL, USA

    Fazeel Siddiqui

  6. Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt a.M., Germany

    Thorsten Steiner

Authors
  1. Jan C. Purrucker
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  2. Matthew L. Flaherty
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  3. Gustavo Rodriguez
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  4. Saqib Chaudhry
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  5. Fazeel Siddiqui
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  6. Thorsten Steiner
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Correspondence to Thorsten Steiner .

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Editors and Affiliations

  1. University of California, San Francisco Medical Center, San Francisco, CA, USA

    Bruce Ovbiagele

  2. University of Minnesota, Minneapolis, MN, USA

    Adnan I. Qureshi

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Purrucker, J.C., Flaherty, M.L., Rodriguez, G., Chaudhry, S., Siddiqui, F., Steiner, T. (2018). Antithrombotic- and Thrombolytic-Related Intracerebral Hemorrhage. In: Ovbiagele, B., Qureshi, A. (eds) Intracerebral Hemorrhage Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-319-77063-5_3

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  • DOI: https://doi.org/10.1007/978-3-319-77063-5_3

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