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Reversal of antithrombotic treatment in intracranial hemorrhage – A review of current strategies and guidelines
Affiliations- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, L. Bierkowski Hospital, Poznań, Poland
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Abstract
In the last few years, there has been a rapid increase in patients being treated with various anticoagulation and antiplatelet agents. In clinical neurology, these drugs are administered for primary and secondary stroke prevention or to avoid the consequences of immobilization of severe stroke patients. Additionally, thrombolytic intravenous therapy and, recently, intra-arterial therapy for stroke have been increasingly employed all over the world. These therapies are associated with an increased risk of hemorrhage, including the most dangerous, intracranial hemorrhage. The knowledge of the standards for the treatment of hemorrhagic complications in the central nervous system is crucial for doctors in neurology and stroke units as well as in emergency rooms. Therefore, we conducted a review of various guidelines and recommendations, including manufacturers’ opinions contained in the summaries of product characteristics (Polish and British or European versions), in Guidelines of the Polish Neurological Society and in international and American guidelines i.e., European Stroke Organization (ESO) and American Heart Association/American Stroke Association (AHA/ASA). In addition, we compared these guidelines with expert opinions published in recent manuscripts and manuals on intensive care in neurology.
Abstract
In the last few years, there has been a rapid increase in patients being treated with various anticoagulation and antiplatelet agents. In clinical neurology, these drugs are administered for primary and secondary stroke prevention or to avoid the consequences of immobilization of severe stroke patients. Additionally, thrombolytic intravenous therapy and, recently, intra-arterial therapy for stroke have been increasingly employed all over the world. These therapies are associated with an increased risk of hemorrhage, including the most dangerous, intracranial hemorrhage. The knowledge of the standards for the treatment of hemorrhagic complications in the central nervous system is crucial for doctors in neurology and stroke units as well as in emergency rooms. Therefore, we conducted a review of various guidelines and recommendations, including manufacturers’ opinions contained in the summaries of product characteristics (Polish and British or European versions), in Guidelines of the Polish Neurological Society and in international and American guidelines i.e., European Stroke Organization (ESO) and American Heart Association/American Stroke Association (AHA/ASA). In addition, we compared these guidelines with expert opinions published in recent manuscripts and manuals on intensive care in neurology.
Keywords
Anticoagulation, Antiplatelet, Intracranial hemorrhage, Coagulopathy
About this articleTitle
Reversal of antithrombotic treatment in intracranial hemorrhage – A review of current strategies and guidelines
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
278-289
Page views
324
Article views/downloads
694
DOI
10.1016/j.pjnns.2015.06.003
Bibliographic record
Neurol Neurochir Pol 2015;49(4):278-289.
Keywords
Anticoagulation
Antiplatelet
Intracranial hemorrhage
Coagulopathy
Authors
Tomasz Grzegorski
Natalia Andrzejewska
Radosław Kaźmierski
