关键词: Activated prothrombin complex concentrates Alteplase Anticoagulant Antidote Antiplatelet Antithrombotic Apixaban Aspirin Clopidogrel Coumadin Cryoprecipitate DDAVP DTI Dabigatran Desmopressin Direct thrombin inhibitor Edoxaban FEIBA FFP Factor Xa inhibitor Fondaparinux Fresh frozen plasma GRADE criteria Guideline Heparin Heparinoid ICH Intracerebral hemorrhage Intracranial hemorrhage Intraparenchymal hemorrhage Low-molecular weight heparin PCC Pentasaccharide Plasminogen activator Platelets Protamine Prothrombin complex concentrates Recombinant factor VIIa Reversal Rivaroxaban SAH SDH Subarachnoid hemorrhage Subdural hematoma TPA Thrombolytic VKA Vitamin K antagonist Warfarin aPCC rFVIIa rtPA

Mesh : Critical Care / standards Fibrinolytic Agents / administration & dosage adverse effects Humans Intracranial Hemorrhages / chemically induced drug therapy Neurology / standards Practice Guidelines as Topic / standards Societies, Medical / standards

来  源:   DOI:10.1007/s12028-015-0222-x   PDF(Sci-hub)

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.
摘要:
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