Medical Treatment for Spontaneous Anticoagulation-Related Intracerebral Hemorrhage in the Netherlands

• Published in: Journal of stroke and cerebrovascular diseases 2017-07, Vol.26 (7), p.1427-1432
• Main Authors: de Schipper, Laura J., MD, Baharoglu, M. Irem, MD, Roos, Yvo B.W.E.M., MD, PhD, de Beer, Frank, MD
• Format: Article
• Language: English
• Subjects: Anticoagulants - adverse effects; anticoagulation reversal; Anticoagulation-related intracerebral hemorrhage; Blood Coagulation - drug effects; Blood Coagulation Tests; Cardiovascular; Cerebral Hemorrhage - blood; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - drug therapy; Coagulants - administration & dosage; Coagulants - adverse effects; coagulopathy; door to reversal; Drug Administration Schedule; Health Care Surveys; Healthcare Disparities; Humans; intracerebral hemorrhage; Netherlands; Neurology; oral anticoagulants; Plasmapheresis - adverse effects; Practice Patterns, Physicians; Predictive Value of Tests; Risk Factors; Time-to-Treatment; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.019

Background Spontaneous anticoagulation-related intracerebral hemorrhage accounts for up to a quarter of spontaneous intracerebral hemorrhage cases and is associated with higher hematoma volume and a worse outcome. Guidelines recommend rapid anticoagulant reversal but mode and timing are not specified and optimal strategy is uncertain. Variability in everyday practice is unknown. Methods An invitation to a web-based survey was sent to 85 Dutch stroke neurologists in different hospitals, with questions about importance, timing, and medical management of spontaneous anticoagulation-related intracerebral hemorrhage. Results In total, 61 (72%) neurologists completed the survey. Nearly all (97%) deemed rapid anticoagulant reversal important. A local guideline for management of anticoagulant reversal was used in 80% of the hospitals. Most neurologists (56%) estimated anticoagulant reversal in anticoagulation-related intracerebral hemorrhage to start later than intravenous thrombolysis in ischemic stroke. Few (5%) thought it was quicker. A minority (28%) of the hospitals started anticoagulation reversal without waiting for laboratory test results or consulting a specialist in hemostasis. Prothrombin complex concentrate was used by all neurologists for vitamin K antagonist reversal and by most (74%) for reversal of thrombin inhibitors and factor Xa inhibitors (72%). Anticoagulation reversal was initiated at the emergency department according to 89% of the respondents. Conclusion Variability in logistics in acute management of spontaneous anticoagulation-related intracerebral hemorrhage was demonstrated. Anticoagulant reversal is deemed important, but is estimated to have a longer door-to-needle time than alteplase in thrombolysis for ischemic stroke by most neurologists. Several delaying factors were found. These factors might have an impact on outcome.