[Hemorrhagic stroke and new oral anticoagulants].

Abstract

The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addition, there is no specific antidote and reversal protocol validated in humans. So, physicians are in a difficult situation when critical bleeding occurs. The timing of recovering normal hemostatic capacity is then a determinant factor of prognosis. Studies in animals or healthy volunteers showed a correction of the biological parameters using prothrombin complex concentrates activated or not, without reducing the volume of hematoma. On this basis, proposals have been issued by the french group of interest for perioperative hemostasis (GIHP) for the management of bleeding under NOAC treatment, which include management of intracranial hemorrhage.

• Authors: V Derlon, G Corbonnois, M Martin, M Toussaint-Hacquard, G Audibert
• Journal: Annales francaises d'anesthesie et de reanimation (Ann Fr Anesth Reanim) 2014 Sep-Oct Vol. 33 Issue 9-10 Pg. 540-7 ISSN: 1769-6623 [Electronic] France
• Vernacular Title: Hémorragies cérébrales et nouveaux anticoagulants.
• PMID: 25282445 (Publication Type: English Abstract, Journal Article, Review)
• Copyright: Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Chemical References

• Anticoagulants
• Benzimidazoles
• Morpholines
• Pyrazoles
• Pyridones
• Thiophenes
• beta-Alanine
• apixaban
• Rivaroxaban
• Dabigatran

Topics

• Anticoagulants (adverse effects, therapeutic use)
• Benzimidazoles (adverse effects, therapeutic use)
• Cerebral Hemorrhage (chemically induced, epidemiology)
• Dabigatran
• Humans
• Morpholines (therapeutic use)
• Pyrazoles (therapeutic use)
• Pyridones (therapeutic use)
• Rivaroxaban
• Stroke (chemically induced, epidemiology)
• Thiophenes (therapeutic use)
• beta-Alanine (adverse effects, analogs & derivatives, therapeutic use)