Evaluation of Anticoagulant Reversal Agents in Acute Intracranial Hemorrhage

Abstract

  Intracranial hemorrhage during anticoagulation therapy has a poor prognosis, and appropriate anticoagulation therapy is important toward the goal of improving the prognosis. We retrospectively analyzed the use of anticoagulant reversal agents at Tokyo Medical and Dental University Hospital and four affiliated facilities. Between January 2017 and September 2023, an anticoagulant reversal agent was used in 72 cases of acute intracranial hemorrhage (hemorrhagic stroke, n=39; traumatic intracranial hemorrhage, n=33). Surgical treatment was selected for 32 cases, six of which were changed from conservative to surgical treatment due to deterioration of conservative therapy. Forty cases were treated conservatively. The time from arrival at the hospital to the administration of the anticoagulant reversal agents was 98 min in the patient group in which surgery was selected from the beginning, 308 min in the group in which the treatment plan was changed to surgery after hospitalization, and 118 min in the conservative treatment group, which was significantly longer compared to the surgery group. In the group that initially chose conservative treatment, 16 patients experienced increased bleeding after hospitalization, and the time until the administration of medication was 101 min in the patients without increased bleeding versus 308 min in those with worsening bleeding, which was significantly longer. Among all of the patients, nine (13%) died in the hospital. These results suggest that effective hemostatic effects may be achieved by administering an anticoagulant Reversal agent soon after admission to the hospital.