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Intracerebral Hemorrhage In Anticoagulated Patients: Evidence-Based Emergency Department Management (Stroke CME)

December 2015

Issue Of The Year

Abstract

Spontaneous intracerebral hemorrhage is a true neurological emergency, and its management is made more complicated when patients are anticoagulated, as reversal of anticoagulation must be initiated simultaneously with diagnosis, treatment, and disposition. Recent advances such as newer laboratory testing and rapid computed tomography for diagnosis, blood pressure reduction to reduce hematoma expansion, and new anticoagulant reversal agents may allow for improved outcomes. Management of intracranial pressure is particularly important in anticoagulated patients, as is identifying patients who may benefit from rapid neurosurgical intervention and/or emergent transport to facilities capable of managing this disease.

Key words: intracerebral hemorrhage, intraventricular hemorrhage, intracranial pressure, stroke, coagulopathy, anticoagulated, anticoagulant, vitamin k antagonist, novel oral anticoagulants, warfarin, clotting, hypertension, fresh-frozen plasma, prothrombin complex concentrate, factors, prothrombin time, dabigatran, rivaroxaban, apixaban, edoxaban, idarucizumab, Praxbind, direct thrombin inhibitor, factor Xa inhibitor, RE-LY, ARISTOTLE, ROCKET AF, ENGAGE AF-TIMI 48, CPSS, rFVIIa

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