Gustavo J. Rodriguez

Antithrombotic- and Thrombolytic-Related Intracerebral Hemorrhage

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.