Treatment strategies for patients with atrial fibrillation and anticoagulant-associated intracranial hemorrhage: an overview of the pharmacotherapy
| Autor: | María Asunción Esteve-Pastor, Francisco Marín, Vanessa Roldán, Gregory Y.H. Lip, Inmaculada Ramírez-Macías, José Miguel Rivera-Caravaca, Anny Camelo-Castillo |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Vitamin K medicine.drug_class Administration Oral direct oral anticoagulants 03 medical and health sciences 0302 clinical medicine Pharmacotherapy Risk Factors Internal medicine Atrial Fibrillation medicine Humans Pharmacology (medical) oral anticoagulants cardiovascular diseases Stroke Pharmacology business.industry intracranial bleeding Anticoagulant Anticoagulants Atrial fibrillation Systemic embolism General Medicine medicine.disease Blood Coagulation Factors Recombinant Proteins nervous system diseases vitamin K antagonists 030220 oncology & carcinogenesis Factor Xa Cardiology Treatment strategy business Intracranial Hemorrhages intracranial hemorrhage 030217 neurology & neurosurgery Intracranial bleeding |
| Zdroj: | Expert Opinion on Pharmacotherapy Rivera-Caravaca, J M, Esteve-Pastor, M A, Camelo-Castillo, A, Ramírez-Macías, I, Lip, G Y H, Roldán, V & Marín, F 2020, ' Treatment strategies for patients with atrial fibrillation and anticoagulant-associated intracranial hemorrhage : an overview of the pharmacotherapy ', Expert Opinion on Pharmacotherapy, vol. 21, no. 15, pp. 1867-1881 . https://doi.org/10.1080/14656566.2020.1789099 |
| ISSN: | 1744-7666 1465-6566 |
| DOI: | 10.1080/14656566.2020.1789099 |
| Popis: | Introduction: Oral anticoagulants (OAC) reduce stroke/systemic embolism and mortality risks in atrial fibrillation (AF). However, there is an inherent bleeding risk with OAC, where intracranial hemorrhage (ICH) is the most feared, disabling, and lethal complication of this therapy. Therefore, the optimal management of OAC-associated ICH is not well defined despite multiple suggested strategies. Areas covered: In this review, the authors describe the severity and risk factors for OAC-associated ICH and the associated implications for using DOACs in AF patients. We also provide an overview of the management of OAC-associated ICH and treatment reversal strategies, including specific and nonspecific reversal agents as well as a comprehensive summary of the evidence about the resumption of DOAC and the optimal timing. Expert opinion: In the setting of an ICH, supportive care/measures are needed, and reversal of anticoagulation with specific agents (including administration of vitamin K, prothrombin complex concentrates, idarucizumab and andexanet alfa) should be considered. Most patients will likely benefit from restarting anticoagulation after an ICH and permanently withdrawn of OAC is associated with worse clinical outcomes. Although the timing of OAC resumption is still under debate, reintroduction after 4–8 weeks of the bleeding event may be possible, after a multidisciplinary approach to decision-making. |
| Databáze: | OpenAIRE |
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