title: Antithrombotic Treatment Management in Patients with Intracerebral Hemorrhage: Reversal and Restart.
abstract: Intracerebral hemorrhage is the pathological accumulation of blood within the brain. It is a type of stroke more likely to be lethal or to severely disable the patient and results from a wide variety of causes. On the other hand antithrombotic therapy is used for the prevention or/and the therapy of thromboembolic episodes. Antithrombotic drugs are very effective in reducing risk or mortality rate after a thromboembolic event, yet they are associated with significant hemorrhages.
  
  
  
  The aim of this article is to review current literature for intracerebral hemorrhage and antithrombotic therapy and offer recommendations on the reversal, the discontinuation and the resumption of antithrombotic therapy.
  
  
  
  Current literature has been reviewed for intracerebral hemorrhage associated with three major categories of patients, those with atrial fibrillation, those with prosthetic mechanical valves and those with venous thromboembolism. Antithrombotic therapy is categorized in antiplatelet agents and anticoagulants. The risk of intracerebral hemorrhage, of a thromboembolic event and of a rebleeding with or without antithrombotic therapy was also reported.
  
  
  
  Although no one can deny the usefulness of antithrombotic therapy a therapeutic strategy should be developed in order to optimize the clinical decision of stopping, reversing and restarting antithrombotic treatment. This review concludes in strong recommendations, yet a multidisciplinary panel by a stroke physician or neurologist, a cardiologist, a neuroradiologist and a neurosurgeon should evaluate the benefits and the risks for each patient and decide the best therapeutic strategy.
authors.affiliation: Department of Neurosurgery, Evangelismos Hospital, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Giakoumettis
authors.affiliation: Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: George A
authors.initials: GA
authors.lastname: Alexiou
authors.affiliation: Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Vrachatis
authors.affiliation: Department of Neurosurgery, Evangelismos Hospital, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Themistoklis
authors.affiliation: Department of Neurology, Mediterraneo Hospital, Glyfada, Athens, Greece.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Stathis
authors.affiliation: Department of Cardiovascular Medicine, Ohio State University, Columbus, OH, United States.
authors.forename: Manolis
authors.initials: M
authors.lastname: Vavuranakis
authors.affiliation: 20 Dimitsanas street, PO: 16672, Athens, Greece.
authors.forename: Marios S
authors.initials: MS
authors.lastname: Themistocleous
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D006801:Humans
chemical_list: D000925:Anticoagulants
keywords: ICH; Intracerebral hemorrhage; anticoagulation; antiplatelets; antithrombotic agents; thromboembolism