| Intracerebral hemorrhage associated with oral anticoagulant therapy: current practices and unresolved questions. | |
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MedLine Citation:
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PMID: 16339459 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Thorsten Steiner; Jonathan Rosand; Michael Diringer |
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Publication Detail:
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Type: Journal Article; Review Date: 2005-12-08 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 37 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2006 Jan |
Date Detail:
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Created Date: 2005-12-23 Completed Date: 2006-02-21 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 256-62 Citation Subset: IM |
Affiliation:
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Department of Neurology, University of Heidelberg, Germany. thorsten_steiner@med.uni-heidelberg.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Anticoagulants / administration & dosage, adverse effects* Cerebral Hemorrhage / chemically induced*, therapy* Clinical Trials as Topic Factor VIIa / metabolism Hemorrhage / chemically induced, therapy Humans Recombinant Proteins / therapeutic use Risk Thrombosis / etiology Vitamin K / metabolism |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Recombinant Proteins; 12001-79-5/Vitamin K; EC 3.4.21.21/Factor VIIa |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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