Document Detail

Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and unresolved questions.
MedLine Citation:
PMID:  16339459     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Life-threatening intracranial hemorrhage, predominantly intracerebral hemorrhage (ICH), is the most serious complication of oral anticoagulant therapy (OAT), with mortality in excess of 50%. Early intervention focuses on rapid correction of coagulopathy in order to prevent continued bleeding. SUMMARY OF REVIEW: This article reviews the epidemiology of OAT-associated ICH (OAT-ICH), and current treatment options, with the aim of providing a framework for future studies of unresolved questions. A number of acute treatments are available, but all have a significant risk of inducing thrombosis and other side effects, and vary in their rapidity of effect: vitamin K (very slow response time), fresh frozen plasma (slow response time, large volume of fluid required, transfusion-related acute lung injury), prothrombin complex concentrates, and recombinant activated factor VII. Current practice is to administer a combination of vitamin K and either fresh frozen plasma or prothrombin complex concentrates; the occasional use of recombinant activated factor VII has been reported. No prospective study has addressed the efficacy of, or outcomes from, the use of these practices. CONCLUSIONS: Current management of OAT-ICH is varied and not based on evidence from randomized controlled trials. Well-designed clinical trials are essential if we are to identify the effective acute treatments for OAT-ICH that are urgently needed.
Thorsten Steiner; Jonathan Rosand; Michael Diringer
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Publication Detail:
Type:  Journal Article; Review     Date:  2005-12-08
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  37     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-23     Completed Date:  2006-02-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  256-62     Citation Subset:  IM    
Department of Neurology, University of Heidelberg, Germany.
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MeSH Terms
Administration, Oral
Anticoagulants / administration & dosage,  adverse effects*
Cerebral Hemorrhage / chemically induced*,  therapy*
Clinical Trials as Topic
Factor VIIa / metabolism
Hemorrhage / chemically induced,  therapy
Recombinant Proteins / therapeutic use
Thrombosis / etiology
Vitamin K / metabolism
Reg. No./Substance:
0/Anticoagulants; 0/Recombinant Proteins; 12001-79-5/Vitamin K; EC VIIa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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