Neurol. praxi. 2014;15(2):83-88

Intracerebral hemorrhage and anticoagulation therapy

prof. MUDr. Roman Herzig, Ph.D., FESO
Neurologická klinika LF UP a FN Olomouc

Anticoagulation therapy is being used in the prevention and therapy of thrombosis and thromboembolism and of related complications, including the prevention of ischemic stroke. Warfarin, heparin (including low-molecular-weight one), but also new oral anticoagulants (e. g. dabigatran, rivaroxaban or apixaban) are being used most frequently for this purpose. The use of anticoagulants may be complicated by hemorrhage, including spontaneous intracerebral hemorrhage (SICH). In the case of the occurrence of SICH in patient on oral anticoagulation, immediate discontinuation of anticoagulation and effort for the most rapid normalization of coagulation parameters are indicated. During decision making about the indication of long-term anticoagulation in the secondary prevention of stroke in patients with a history of SICH, comparison of the risk of SICH recurrence and the risk of ischemic vascular disease is needed.

Keywords: intracerebral hemorrhage, anticoagulant therapy, warfarin, new oral anticoagulants, ischemic stroke, prevention

Published: May 10, 2014  Show citation

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Herzig R. Intracerebral hemorrhage and anticoagulation therapy. Neurol. praxi. 2014;15(2):83-88.
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References

  1. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF; American Heart Association; American Stroke Association Stroke Council; Clinical Cardiology Council; Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38: 1655-1711. Go to original source... Go to PubMed...
  2. Boulis NM, Bobek MP, Schmaier A, Hoff JT. Use of factor IX complex in warfarin-related intracranial hemorrhage. Neurosurgery 1999; 45: 1113-1118. Go to original source... Go to PubMed...
  3. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P; ESC Committee for Practice Guidelines (CPG), Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S; Document Reviewers, Vardas P, Al-Attar N, Alfieri O, Angelini A, Blömstrom-Lundqvist C, Colonna P, De Sutter J, Ernst S, Goette A, Gorenek B, Hatala R, Heidbüchel H, Heldal M, Kristensen SD, Kolh P, Le Heuzey JY, Mavrakis H, Mont L, Filardi PP, Ponikowski P, Prendergast B, Rutten FH, Schotten U, Van Gelder IC, Verheugt FW. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33: 2719-2747. Go to original source...
  4. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139-1151. Go to original source... Go to PubMed...
  5. Eckman MH, Rosand J, Knudsen KA, Singer DE, Greenberg SM. Can patients be anticoagulated after intracerebral hemorrhage? A decision analysis. Stroke 2003; 34: 1710-1716. Go to original source... Go to PubMed...
  6. Fredriksson K, Norrving B, Strömblad LG. Emergency reversal of anticoagulation after intracerebral hemorrhage. Stroke 1992; 23: 972-977. Go to original source... Go to PubMed...
  7. Goldstein JN, Thomas SH, Frontiero V, Joseph A, Engel C, Snider R, Smith EE, Greenberg SM, Rosand J. Timing of fresh frozen plasma administration and rapid correction of coagulopathy in warfarin-related intracerebral hemorrhage. Stroke 2006; 37: 151-155. Go to original source... Go to PubMed...
  8. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981-992. Go to original source... Go to PubMed...
  9. Hanley JP. Warfarin reversal. J Clin Pathol 2004; 57: 1132-1139. Go to original source... Go to PubMed...
  10. Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol 2008; 83: 137-143. Go to original source... Go to PubMed...
  11. Lubetsky A, Yonath H, Olchovsky D, Loebstein R, Halkin H, Ezra D. Comparison of oral vs intravenous phytonadione (vitamin K1) in patients with excessive anticoagulation: a prospective randomized controlled study. Arch Intern Med 2003; 163: 2469-2473. Go to original source... Go to PubMed...
  12. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, Greenberg SM, Huang JN, MacDonald RL, Messé SR, Mitchell PH, Selim M, Tamargo RJ; American Heart Association Stroke Council and Council on Cardiovascular Nursing. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41: 2108-2129. Go to original source... Go to PubMed...
  13. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365: 883-891. Go to original source... Go to PubMed...
  14. Příloha I - Souhrn údajů u přípravku Eliquis. Available from: URL: http://www.ema.europa.eu/docs/cs_CZ/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf.
  15. Příloha I - Souhrn údajů u přípravku Pradaxa. Available from: URL: http://www.emea.europa.eu/docs/cs_CZ/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf.
  16. Příloha I - Souhrn údajů u přípravku Xarelto. Available from: URL: http://www.emea.europa.eu/docs/cs_CZ/document_library/EPAR_-_Product_Information/human/000944/WC500057108.pdf.
  17. Sjöblom L, H?rdemark HG, Lindgren A, Norrving B, Fahlén M, Samuelsson M, Stigendal L, Stockelberg D, Taghavi A, Wallrup L, Wallvik J. Management and prognostic features of intracerebral hemorrhage during anticoagulant therapy: a Swedish multicenter study. Stroke 2001; 32: 2567-2574. Go to original source... Go to PubMed...
  18. Steiner T, Kaste M, Forsting M, Mendelow D, Kwiecinski H, Szikora I, Juvela S, Marchel A, Chapot R, Cognard C, Unterberg A, Hacke W. Recommendations for the management of intracranial haemorrhage - part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis 2006; 22: 294-316. Go to original source... Go to PubMed...
  19. The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25: 457-507. Go to original source... Go to PubMed...
  20. Vergouwen MD, Casaubon LK, Swartz RH, Fang J, Stamplecoski M, Kapral MK, Silver FL; Investigators of the Registry of the Canadian Stroke Network. Subtherapeutic warfarin is not associated with increased hemorrhage rates in ischemic strokes treated with tissue plasminogen activator. Stroke 2011; 42: 1041-1045. Go to original source... Go to PubMed...
  21. Xian Y, Liang L, Smith EE, Schwamm LH, Reeves MJ, Olson DM, Hernandez AF, Fonarow GC, Peterson ED. Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator. JAMA 2012; 307: 2600-2608. Go to original source... Go to PubMed...




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