title: [Hemorrhagic stroke and new oral anticoagulants].
abstract: The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addition, there is no specific antidote and reversal protocol validated in humans. So, physicians are in a difficult situation when critical bleeding occurs. The timing of recovering normal hemostatic capacity is then a determinant factor of prognosis. Studies in animals or healthy volunteers showed a correction of the biological parameters using prothrombin complex concentrates activated or not, without reducing the volume of hematoma. On this basis, proposals have been issued by the french group of interest for perioperative hemostasis (GIHP) for the management of bleeding under NOAC treatment, which include management of intracranial hemorrhage.
authors.affiliation: Service d'anesthésie-réanimation, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
authors.forename: V
authors.initials: V
authors.lastname: Derlon
authors.affiliation: Service d'anesthésie-réanimation, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
authors.forename: G
authors.initials: G
authors.lastname: Corbonnois
authors.affiliation: Service d'hématologie biologique, CHU de Brabois, 4, rue de Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Martin
authors.affiliation: Service d'hématologie biologique, CHU de Brabois, 4, rue de Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Toussaint-Hacquard
authors.affiliation: Service d'anesthésie-réanimation, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France. Electronic address: g.audibert@chu-nancy.fr.
authors.forename: G
authors.initials: G
authors.lastname: Audibert
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D000069604:Dabigatran; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology; D013876:Thiophenes / Q000627:therapeutic use; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Apixaban; Dabigatran; Hemorrhagic stroke; Hémorragie cérébrale; New oral anticoagulants; Nouveaux anticoagulants oraux; Rivaroxaban