title: New Target-Specific Oral Anticoagulants and Intracranial Bleeding: Management and Outcome in a Single-Center Case Series.
abstract: BACKGROUND
  New target-specific anticoagulants such as the direct thrombin inhibitor dabigatran and the factor Xa inhibitor rivaroxaban are used in an increasing number of patients. Several studies comparing these new oral anticoagulants with vitamin K antagonists revealed a lower risk of severe bleeding complications and reduced thromboembolic events. However, the lack of antidotes is a challenging issue in the treatment of traumatic or spontaneous intracranial hemorrhage.
  
  
  METHODS
  A retrospective analysis of patients with intracranial bleeding under new oral anticoagulants was performed; these patients were admitted to our department between January 2011 and November 2014. Treatment, reversal management of blood coagulopathy, and outcome of the patients were analyzed.
  
  
  RESULTS
  Seventeen patients were included. The median age was 80.4 years. Seven patients were treated with dabigatran and 10 with rivaroxaban. Eight patients had traumatic intracranial bleeding and 9 patients had spontaneous intracranial hemorrhage. Complex perioperative hematologic treatment followed. In 9 cases, the clinical outcome was devastating with severe neurologic deficits (n = 2), comatose status (n = 4), or death (n = 3). Patients with the indication for acute surgical treatment had a high risk for a critical clinical outcome.
  
  
  CONCLUSIONS
  Only a few case reports have analyzed the clinical course and the outcome after intracranial bleeding under new target-specific oral anticoagulants. Here, one of the first larger series is presented. Because of the lack of reversibility of the anticoagulative effects and the overall risks with geriatric patients, surgical treatment should be delayed as long as possible and comorbidities have to be considered.
authors.affiliation: Department of Neurosurgery, Medical School of the Saarland University, Homburg/Saar, Germany. Electronic address: sebastian.senger@uks.eu.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Senger
authors.affiliation: Department of Neurosurgery, Medical School of the Saarland University, Homburg/Saar, Germany.
authors.forename: Dörthe
authors.initials: D
authors.lastname: Keiner
authors.affiliation: Department of Neurosurgery, Medical School of the Saarland University, Homburg/Saar, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Hendrix
authors.affiliation: Department of Neurosurgery, Medical School of the Saarland University, Homburg/Saar, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Oertel
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000145:classification; D000991:Antithrombins / Q000008:administration & dosage; D000069604:Dabigatran / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000008:administration & dosage*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Dabigatran; Intracerebral hemorrhage; Intracranial hemorrhage; Neurosurgical treatment; New target specific oral anticoagulants; Rivaroxaban