Haemostatic Management of Intracranial Bleeding in Patients Treated with Oral Anticoagulants

Abstract

Spontaneous intracranial haemorrhages have a bad clinical prognosis. The future of patients is related to the efficacy of the initial care. The magnitude of bleeding, the volume and the evolution of the haematoma are the main predictive factors for morbidity and mortality. Vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs) promote the expansion of bleeding. A rapid normalization of coagulation allows a partial control of the haematoma. Although prothrombin complex concentrates (PCC) are now the standard of care for VKA reversal, only one specific antidote for dabigatran is approved and the experience with PCC for anti-Xa agents is limited. No antidote is available yet for these agents.