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Management of Antithrombotic-Related Intracerebral Hemorrhage

  • Tarun Girotra
  • Wuwei Feng
  • Bruce Ovbiagele
Chapter
Part of the Stroke Revisited book series (STROREV)

Abstract

Even though hemorrhagic stroke is less common than ischemic stroke, the former is generally associated with worse clinical outcomes. Intracerebral hemorrhage (ICH) is a key type of hemorrhagic stroke, with a variety of important causes including antithrombotic-related ICH. Antithrombotic-related ICH accounts for about 8–14% of all ICH and is linked to much poorer prognosis than ICH without antithrombotic use. Indeed, iatrogenic coagulopathy poses a unique challenge to emergency medicine physicians, vascular neurologists, neurointensivists, and neurosurgeons. This is because premorbid use of an anticoagulant or antiplatelet agent can quickly and significantly foster hematoma growth within the first 24 h of ictus thereby leading to poor ICH outcomes. However, timely and appropriate administration of reversal agents can mitigate the extent of hematoma growth and lower the risk of a devastating outcome. In this chapter, we review the epidemiology of commonly used outpatient antiplatelet- and anticoagulant-related ICH, discuss the pharmacology of these antithrombotic drugs and their reversal agents, outline the general and specific management of antithrombotic-related ICH, and highlight areas for future research.

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Copyright information

© Springer Science+Business Media Singapore 2018

Authors and Affiliations

  1. 1.Medical University of South CarolinaCharlestonUSA
  2. 2.Department of NeurologyMedical University of South CarolinaCharlestonUSA

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