International Stroke Conference
Danny R. Rose, Jr., MD
New advances in our understanding of intracerebral hemorrhage in recent years have led to new questions, as well as revisiting previously held notions about treatment and prevention. The talks in this session covered coagulopathy reversal, anticoagulant usage in patients with a history of ICH, the relationship between statins and ICH and anti-edema therapy.
Dr. Thorsten Steiner, MD, PhD, began the session by discussing drug-induced coagulopathy reversal in ICH. The primary purpose of such therapies is to prevent hematoma expansion, which occurs in 30% of cases in the first 4 hours after ICH and is associated with increased morbidity and mortality. Anticoagulants increase this rate to upwards of 54% for vitamin K antagonists (VKAs) and 38% with direct-acting oral anticoagulants (DOACs). Timing is an important thing to consider in this scenario, given the half-life of VKAs are around 2 days, while DOACs are all around 14 hours, with peak effect somewhere between 3–4 hours. Specifically, many patients on DOACs may present in a time window when reversal would have little to no effect given the lack of active drug at the time. It is important to consider things that may cause variations in half-life for DOACs, including body size, inhibiting/inducing medications, and renal function (most important for dabigatran).