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Baranich A.I.
Burdenko Neurosurgical Center;
Plekhanov Russian University of Economics
Sychev A.A.
Burdenko Neurosurgical Center
Savin I.A.
Burdenko Neurosurgical Center
Kudrina V.G.
Plekhanov Russian University of Economics;
Russian Medical Academy of Continuous Professional Education
Kozlov A.V.
Burdenko Neurosurgical Center;
Andijan State Medical Institute
Correction of the effect of vitamin K antagonists and antiplatelet agents in hemorrhagic stroke
Journal: Burdenko's Journal of Neurosurgery. 2024;88(6): 103‑109
Views: 801
Downloaded: 49
To cite this article:
Baranich AI, Sychev AA, Savin IA, Kudrina VG, Kozlov AV. Correction of the effect of vitamin K antagonists and antiplatelet agents in hemorrhagic stroke. Burdenko's Journal of Neurosurgery.
2024;88(6):103‑109. (In Russ., In Engl.)
https://doi.org/10.17116/neiro202488061103
Hemorrhagic stroke (HS) is associated with high risk of mortality or disability. To date, up to 25% of HSs are associated with anticoagulants and antiplatelet agents. Early hemostatic therapy and correction of effect of antithrombotic drugs in patients with HS significantly reduce the risk of adverse outcomes. The latest international guidelines on this issue were presented almost 10 years ago.
In accordance with the PRISMA recommendations, we reviewed the PubMed, eLibrary and UpToDate databases and identified 137 articles. Of these, 52 were enrolled as the most relevant.
Regarding correction of the effect of indirect anticoagulants, various researchers discuss the possibility of either individual dosing or injection of a fixed dose of 4- or 3-factor prothrombin complex (1000—2000 IU regardless of body weight and international normalized ratio). To correct the effect of antiplatelet agents, platelet transfusion and desmopressin are proposed. There is currently no evidence of safety and effectiveness of both methods in patients with HS.
The optimal drug for correction of the effect of indirect anticoagulants is 4- or 3-factor prothrombin complex. In the last case, it is necessary to administer factor VIIa or fresh frozen plasma, as well as parenteral form of phytomenadione (vitamin K1) in all cases. The issue of correction of the effects of antiplatelet agents remains open. Regular analysis of available data with updating the guidelines for correction of the effect of anticoagulants and antiplatelet agents in HS is necessary.
Keywords:
Authors:
Baranich A.I.
Burdenko Neurosurgical Center;
Plekhanov Russian University of Economics
Sychev A.A.
Burdenko Neurosurgical Center
Savin I.A.
Burdenko Neurosurgical Center
Kudrina V.G.
Plekhanov Russian University of Economics;
Russian Medical Academy of Continuous Professional Education
Kozlov A.V.
Burdenko Neurosurgical Center;
Andijan State Medical Institute
Received:
18.07.2024
Accepted:
20.09.2024
List of references:
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