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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
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Reversing Direct Oral Anticoagulants in Acute Intracranial Hemorrhage

Melissa A Nestor1, Bryan Boling2

  • 1Melissa A. Nestor is a neurosciences critical care pharmacist at the University of Kentucky, Lexington, Kentucky, with research interests in sepsis, neurologic injury, and ischemic stroke; Bryan Boling is an advanced practice provider with the Department of Anesthesiology, Division of Critical Care at the University of Kentucky.

Critical Care Nurse
|June 3, 2019
PubMed

Intracerebral hemorrhage is a major source of morbidity and mortality, accounting for 10% of all strokes. Oral anticoagulation therapy, while necessary to prevent thromboembolic complications, increases the risk of intracerebral hemorrhage and can potentially worsen bleeding in cases of acute hemorrhage. Before the introduction of direct oral anticoagulant agents in 2010, warfarin was the only option for oral anticoagulation. These new agents have an improved safety profile compared with warfarin but require different reversal strategies. Anticoagulation reversal in the setting of acute intracerebral hemorrhage is an evolving field. This article covers the most common direct oral anticoagulant medications, various available anticoagulant reversal strategies, and the latest guidelines for anticoagulation reversal in patients with acute intracranial hemorrhage.

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