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Anticoagulation in Acute Neurological Disease
Cina Sasannejad1, Kevin N Sheth1
1Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut.
Seminars in Neurology
|October 7, 2021
Summary
Direct oral anticoagulants offer safer options for neurological conditions. This review covers their use, safety, and reversal in stroke and hemorrhage, considering patient factors.
Area of Science:
- Neurology
- Pharmacology
Background:
- Anticoagulation is crucial for preventing neurological sequelae of prothrombotic states.
- Direct oral anticoagulants (DOACs) offer safer alternatives to warfarin.
- Advances in reversal agents enhance DOAC safety.
Purpose of the Study:
- To review the use of anticoagulants in neurological disease.
- To examine indications, safety, and reversal strategies for anticoagulants.
- To discuss clinical scenarios involving anticoagulation in neurology.
Main Methods:
- Literature review of anticoagulation and reversal agents.
- Analysis of DOACs in neurological contexts.
- Case-based discussion of clinical factors.
Main Results:
- DOACs provide effective anticoagulation with improved safety profiles.
- Reversal agents are available for DOACs, aiding management of bleeding.
- Clinical decision-making requires consideration of intracranial pathology, comorbidities, and patient demographics.
Conclusions:
- DOACs represent a significant advancement in managing thrombotic risks in neurological disease.
- Careful patient selection and monitoring are essential for safe anticoagulation.
- Understanding reversal strategies is critical for managing complications.
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