Advances in the medical treatment and diagnosis of intracranial hemorrhage associated with oral anticoagulation.

IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Expert Review of Neurotherapeutics Pub Date : 2024-09-01 Epub Date: 2024-07-22 DOI:10.1080/14737175.2024.2379413
Claudio Piqueras-Sanchez, María Asunción Esteve-Pastor, Jorge Moreno-Fernandez, Eva Soler-Espejo, José Miguel Rivera-Caravaca, Vanessa Roldán, Francisco Marín
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Abstract

Introduction: With the increasing prevalence of atrial fibrillation (AF), it entails expanding oral anticoagulants (OACs) use, carrying a higher risk of associated hemorrhagic events, including intracranial hemorrhage (ICH). Despite advances in OACs development with a better safety profile and reversal agent for these anticoagulants, there is still no consensus on the optimal management of patients with OACs-associated ICH.

Areas covered: In this review, the authors have carried out an exhaustive search on the advances in recent years. The authors provide an update on the management of ICH in anticoagulated patients, as well as an update on the latest evidence on anticoagulation resumption, recent therapeutic strategies, and investigational drugs that could play a role in the future.

Expert opinion: Following an ICH event in an anticoagulated patient, a comprehensive clinical evaluation is imperative. Anticoagulation should be promptly withdrawn and reversed. Once the patient is stabilized, a reintroduction of anticoagulation should be considered, typically within a timeframe of 4-8 weeks, if feasible. If re-anticoagulation is not possible, alternative options such as Left Atrial Appendage Occlusion are available.

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与口服抗凝药有关的颅内出血的医疗和诊断进展。
导言:随着心房颤动(房颤)发病率的增加,口服抗凝药(OACs)的使用范围也随之扩大,导致相关出血性事件(包括颅内出血(ICH))的风险也随之升高。尽管口服抗凝药的研发取得了进展,安全性和逆转剂也得到了改善,但对于口服抗凝药相关 ICH 患者的最佳治疗方法仍未达成共识:在这篇综述中,作者对近年来的进展进行了详尽的研究。作者提供了有关抗凝患者 ICH 治疗的最新情况,以及有关恢复抗凝的最新证据、最新治疗策略和未来可能发挥作用的研究药物的最新情况:抗凝患者发生 ICH 事件后,必须进行全面的临床评估。应立即撤消和撤销抗凝治疗。患者病情稳定后,如果可行,应考虑在 4-8 周内重新开始抗凝治疗。如果无法重新进行抗凝治疗,也可以选择其他方法,如左心房阑尾闭塞术。
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来源期刊
Expert Review of Neurotherapeutics
Expert Review of Neurotherapeutics Medicine-Neurology (clinical)
CiteScore
7.00
自引率
2.30%
发文量
61
审稿时长
4-8 weeks
期刊介绍: Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points
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