title: NOAC and intracerebral bleeding--presentation of four cases and review of the literature.
abstract: AF might be a life threatening disease. Patients have been under oral antithrombotic treatment in order to avoid thrombotic events. Although this treatment proved to be effective in the last decades there was always the inconvenience of a regular blood control. In the last months NOACs have been flooding the market promising to be as effective as their older concurrents in certain circumstances and highlighting the fact that the control of INR has become obsolete. However, as there is no specific antidote up to date, NOACs might present a life threatening event in case of an intracerebral haemorrhage. The brain surgeons might find themselves in a difficult situation when they have to decide whether to operate on a patient with a compromised haemostasis or not. We present four patients who were treated with NOACs for AF. Three of them were admitted with intracerebral haemorrhage in our neurosurgical unit from January to October 2013. The fourth patient bled one week after stopping his treatment with NOAC. Furthermore we take a closer look to the existing literature and try to portray the issue from a neurosurgical point of view.
authors.forename: A
authors.initials: A
authors.lastname: Hana
authors.forename: C
authors.initials: C
authors.lastname: Berthold
authors.forename: V R N
authors.initials: VR
authors.lastname: Gunness
authors.forename: A
authors.initials: A
authors.lastname: Hana
authors.forename: G
authors.initials: G
authors.lastname: Dooms
authors.forename: H
authors.initials: H
authors.lastname: Standhardt
authors.forename: J
authors.initials: J
authors.lastname: Koy
authors.forename: G
authors.initials: G
authors.lastname: Matgé
authors.forename: H
authors.initials: H
authors.lastname: Boecher-Schwarz
authors.forename: F
authors.initials: F
authors.lastname: Hertel
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000601:surgery / Q000628:therapy*; D000069604:Dabigatran; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D009025:Morpholines / Q000009:adverse effects; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D000069552:Rivaroxaban; D000069604:Dabigatran