Περίληψη:
Background Intracerebral hemorrhage (ICH)1 is characterized by the pathological accumulation of blood within the brain parenchyma, most commonly associated with hypertension, arteriovenous malformations, or trauma. However, it can also present in patients receiving antithrombotic drugs, either anticoagulants such as acenocoumarol/warfarin—novel oral anticoagulants or antiplatelets, for the prevention and treatment of thromboembolic disease. Objective The purpose of this review is to present current bibliographic data regarding ICH irrespective of the cause, as well as post-hemorrhage use of antithrombotic agents. Moreover, this review attempts to provide guidelines concerning the termination, inversion, and of course resumption of antithrombotic therapy. Methods and Materials We reviewed the most recently presented available data for patients who dealt with intracerebral hemorrhagic events while on antithrombotic agents (due to atrial fibrillation, prosthetic mechanical valves or recent/recurrent deep vein thrombosis). Furthermore, we examined and compared the thromboembolic risk, the bleeding risk, as well as the re-bleeding risk in two groups: Patients receiving antithrombotic therapy versus patients not on antithrombotic therapy. Conclusion Antithrombotic therapy is of great importance when indicated, though it does not come without crucial side-effects, such as ICH. Optimal timing of withdrawal, reversal, and resumption of antithrombotic treatment should be determined by a multidisciplinary team consisting of a stroke specialist, a cardiologist, and a neurosurgeon, who will individually approach the needs and risks of each patient. © 2020 Dimitrios Giakoumettis et al.
Συγγραφείς:
Giakoumettis, D.
Vrachati, D.A.
Panagopoulos, D.
Loukina, A.
Tsitsinakis, G.
Apostolopoulou, K.
Giannopoulos, G.
Giotaki, S.G.
Deftereos, S.
Themistocleous, M.S.
Λέξεις-κλειδιά:
acetylsalicylic acid; andexanet alfa; anticoagulant agent; apixaban; ardeparin; argatroban; clopidogrel; dabigatran; dalteparin; edoxaban; enoxaparin; fondaparinux; heparin; idarucizumab; low molecular weight heparin; prasugrel; recombinant plasminogen activator; rivaroxaban; streptokinase; ticagrelor; ticlopidine; tissue plasminogen activator; warfarin; anticoagulant agent; antidote; antithrombocytic agent; fibrinolytic agent, anticoagulant therapy; anticoagulation; artery thrombosis; atrial fibrillation; bleeding; brain hemorrhage; brain infarction; clinical trial (topic); constipation; deep vein thrombosis; delirium; drug half life; drug mechanism; fever; headache; hematoma; human; hypertension; hypokalemia; lung embolism; meta analysis (topic); mortality rate; peptic ulcer; pneumonia; recurrent disease; Review; risk factor; scoring system; thrombosis prevention; venous thromboembolism; brain hemorrhage; organization and management; pathology; patient care; practice guideline; thromboembolism, Anticoagulants; Antidotes; Cerebral Hemorrhage; Fibrinolytic Agents; Humans; Patient Care Team; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Thromboembolism
