MANAGEMENT OF ORAL ANTICOAGULANT-INDUCED INTRACRANIAL HEMORRHAGE

Authors
Citation
Ac. Butler et Rc. Tait, MANAGEMENT OF ORAL ANTICOAGULANT-INDUCED INTRACRANIAL HEMORRHAGE, Blood reviews, 12(1), 1998, pp. 35-44
Citations number
78
Categorie Soggetti
Hematology
Journal title
ISSN journal
0268960X
Volume
12
Issue
1
Year of publication
1998
Pages
35 - 44
Database
ISI
SICI code
0268-960X(1998)12:1<35:MOOAIH>2.0.ZU;2-S
Abstract
Intracranial haemorrhage is an infrequent but often fatal complication of oral anticoagulant therapy which will become more common as antico agulant use increases. The risk of anticoagulant-induced intracranial haemorrhage may be reduced by judicious prescribing, identification of patients at high risk of bleeding, and close monitoring by experience d staff, The presenting features of intracranial haemorrhage are often vague and physicians should be aware of the need for urgent investiga tion of all anticoagulated patients with neurological symptoms. Curren t guidelines for immediate reversal of anticoagulation recommend admin istration of vitamin K-1 and factor replacement with either factor con centrates or fresh frozen plasma. In this review we discuss recent evi dence suggesting prothrombin complex concentrates lead to faster, and more complete, correction of coagulation and, in the context of intrac ranial bleeding, may be associated with improved neurological status. Evidence for the risks of short-term cessation of anticoagulants, in t he immediate period following an intracranial haemorrhage, and their s ubsequent reintroduction is also discussed.