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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 direct oral and parenteral anticoagulants in hemorrhagic stroke
Journal: Burdenko's Journal of Neurosurgery. 2025;89(1): 109‑115
Views: 711
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To cite this article:
Baranich AI, Sychev AA, Savin IA, Kudrina VG, Kozlov AV. Correction of the effect of direct oral and parenteral anticoagulants in hemorrhagic stroke. Burdenko's Journal of Neurosurgery.
2025;89(1):109‑115. (In Russ., In Engl.)
https://doi.org/10.17116/neiro202589011109
Hemorrhagic stroke is associated with high risk of adverse outcome and follows intake of anticoagulants and antiplatelet agents in 25% of cases. The latest clinical guidelines of the Neurocritical Care Society for correction (reversal) of the effect of anticoagulants and antiplatelet agents in hemorrhagic stroke were published in 2016.
In accordance with PRISMA recommendations, we reviewed the PubMed, eLibrary and UpToDate databases to a depth of 5 years and selected 48 articles.
Direct oral anticoagulants are currently common. To reverse their effect, one can use specific antidotes (idarucizumab is recommended for dabigatran, andexanet alfa (not yet registered In Russia) for factor Xa inhibitors (rivaroxaban, apixaban)) and combination of prothrombin complex concentrate and tranexamic acid. Protamine sulfate is antidote for unfractionated and low molecular weight heparins. Protamine sulfate completely inactivates unfractionated heparin, but it is less effective against low molecular weight heparin. It is characterized by high probability of anaphylactic reactions, especially after repeated administrations. The effectiveness of andexanet alpha and activated factor VII for reversing the effect of low molecular weight heparin is being studied. Fondaparinux sodium is used for heparin-induced thrombocytopenia. Protamine sulfate is ineffective for reversing the effect of fondaparinux. One can use prothrombin complex concentrate and andexanet alpha, but their effectiveness is unclear. Ciraparantag is being studied in clinical trials. Apparently, ciraparantag is highly effective as an antidote for various anticoagulants.
Early hemostatic therapy and reversal of anticoagulant effects in patients with hemorrhagic stroke significantly reduce the risk of adverse outcomes. This problem is being studied. Regular literature review with creation of updated clinical guidelines is needed.
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:
21.11.2024
List of references:
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