title: Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine.
abstract: BACKGROUND
  The use of antithrombotic agents, including anticoagulants, antiplatelet agents, and thrombolytics has increased over the last decade and is expected to continue to rise. Although antithrombotic-associated intracranial hemorrhage can be devastating, rapid reversal of coagulopathy may help limit hematoma expansion and improve outcomes.
  
  
  METHODS
  The Neurocritical Care Society, in conjunction with the Society of Critical Care Medicine, organized an international, multi-institutional committee with expertise in neurocritical care, neurology, neurosurgery, stroke, hematology, hemato-pathology, emergency medicine, pharmacy, nursing, and guideline development to evaluate the literature and develop an evidence-based practice guideline. Formalized literature searches were conducted, and studies meeting the criteria established by the committee were evaluated.
  
  
  RESULTS
  Utilizing the GRADE methodology, the committee developed recommendations for reversal of vitamin K antagonists, direct factor Xa antagonists, direct thrombin inhibitors, unfractionated heparin, low-molecular weight heparin, heparinoids, pentasaccharides, thrombolytics, and antiplatelet agents in the setting of intracranial hemorrhage.
  
  
  CONCLUSIONS
  This guideline provides timely, evidence-based reversal strategies to assist practitioners in the care of patients with antithrombotic-associated intracranial hemorrhage.
authors.affiliation: The Cerebrovascular Center, Neurological Institute, Cleveland Clinic and Case Western Reserve University, 9500 Euclid Ave. S80, Cleveland, OH, 44195, USA. frontej@ccf.org.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Frontera
authors.affiliation: The Departments of Pharmacy and Anesthesiology & Critical Care Medicine, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Lewin
authors.affiliation: The Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Imo P
authors.initials: IP
authors.lastname: Aisiku
authors.affiliation: The University of Tennessee Health Science Center, Memphis, TN, USA.|Australian Catholic University, Sydney, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Department of Pharmacy (UK Healthcare) & Department of Pharmacy Practice & Science (UK College of Pharmacy), University of Kentucky, Lexington, KY, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Cook
authors.affiliation: The Departments of Medicine (Hematology) and Neurology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: del Zoppo
authors.affiliation: The Departments of Neurology, Neurosurgery, Anesthesiology & Critical Care, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Monisha A
authors.initials: MA
authors.lastname: Kumar
authors.affiliation: The Department of Laboratory Medicine and Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical School, New York, NY, USA.
authors.forename: Ellinor I B
authors.initials: EI
authors.lastname: Peerschke
authors.affiliation: The Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stiefel
authors.affiliation: Hôpital du Sacré-Coeur and University of Montreal and Montreal Neurological Institute and McGill University, Montreal, Quebec, Canada.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Teitelbaum
authors.affiliation: Klinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
authors.forename: Katja E
authors.initials: KE
authors.lastname: Wartenberg
authors.affiliation: The Neuroscience and Neurosurgery Departments, Centra Lynchburg General Hospital, Lynchburg, VA, USA.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Zerfoss
mesh_terms: D003422:Critical Care / Q000592:standards*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000188:drug therapy*; D009462:Neurology / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*
chemical_list: D005343:Fibrinolytic Agents
keywords: Activated prothrombin complex concentrates; Alteplase; Anticoagulant; Antidote; Antiplatelet; Antithrombotic; Apixaban; Aspirin; Clopidogrel; Coumadin; Cryoprecipitate; DDAVP; DTI; Dabigatran; Desmopressin; Direct thrombin inhibitor; Edoxaban; FEIBA; FFP; Factor Xa inhibitor; Fondaparinux; Fresh frozen plasma; GRADE criteria; Guideline; Heparin; Heparinoid; ICH; Intracerebral hemorrhage; Intracranial hemorrhage; Intraparenchymal hemorrhage; Low-molecular weight heparin; PCC; Pentasaccharide; Plasminogen activator; Platelets; Protamine; Prothrombin complex concentrates; Recombinant factor VIIa; Reversal; Rivaroxaban; SAH; SDH; Subarachnoid hemorrhage; Subdural hematoma; TPA; Thrombolytic; VKA; Vitamin K antagonist; Warfarin; aPCC; rFVIIa; rtPA