Intracranial Bleeding Management in Anticoagulated Patients

Abstract

Intracranial bleeding is a common complication in patients who are on anticoagulant therapy. There are various brain pathologies known to lead to bleeding, two of them being spontaneous or traumatic intracranial haemorrhage which are identified to increase the risk of neurological deterioration and morbidity in the future. The most common anticoagulation therapies used are direct oral anticoagulants, heparins and warfarin. The aim of this paper is to show what kind of anticoagulation therapies are used in patients nowadays and how we reverse and manage it, in case of intracranial bleeding. Reversing the anticoagulant drug is quite group-specific and also depends on the indication, such as emergency surgical intervention. Management strategies for this group of patients include surgical and conservative measures which depend on the clinical case. When it comes to restart of anticoagulation therapy, clinicians encounter a dilemma, having to outweigh the risks of thrombosis complications or promoting the progression of haemorrhage, mostly due to lack of general guidelines with backed up evidence. The general prognosis of anticoagulated patients with intracranial haemorrhage (ICH) presents with a higher mortality, contrary to non-anticoagulated patients, reaching its peak within the first 24 hours after disease onset and having a rather unfavourable functional outcome. Generally, a multidisciplinary approach when treating those patients is suggested. Due to the lack of clinical trials and reliable data, further trials and research is required in order to develop uniform guidelines when treating anticoagulated patients with ICH.