Correction of the effect of direct oral and parenteral anticoagulants in hemorrhagic stroke

Baranich A.I.; Sychev A.A.; Savin I.A.; Kudrina V.G.; Kozlov A.V.

doi:https://doi.org/10.17116/neiro202589011109

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BACKGROUND

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.

MATERIAL AND METHODS

In accordance with PRISMA recommendations, we reviewed the PubMed, eLibrary and UpToDate databases to a depth of 5 years and selected 48 articles.

RESULTS AND DISCUSSION

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.

CONCLUSION

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:

hemorrhagic stroke

anticoagulants

DOAC

heparin

antidotes

Authors:

Baranich A.I.

Burdenko Neurosurgical Center;
Plekhanov Russian University of Economics

RSCI AuthorID: 1006875
Scopus AuthorID: 57202735861
ORCID: 0000-0002-1167-0742

Sychev A.A.

Burdenko Neurosurgical Center

SPIN RSCI: 1171-7690
Scopus AuthorID: 36997601100
ORCID: 0000-0002-0038-1005

Savin I.A.

Burdenko Neurosurgical Center

SPIN RSCI: 1342-7065
Scopus AuthorID: 35974373500
ORCID: 0000-0003-3874-4147

Kudrina V.G.

Plekhanov Russian University of Economics;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0002-4329-1165

Kozlov A.V.

Burdenko Neurosurgical Center;
Andijan State Medical Institute

ORCID: 0000-0002-3181-6470

Received:

18.07.2024

Accepted:

21.11.2024

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