Tratamiento de la Hemorragia Intracerebral Espontánea en Pacientes con un Inhibidor Directo del Factor Xa
La hemorragia intracerebral espontánea que ocurre en un paciente tratado activamente con un inhibidor directo del factor Xa — rivaroxabán, apixabán o edoxabán — representa una emergencia que requiere reversión inmediata y estructurada de la anticoagulación para limitar la expansión del hematoma.
El paciente se presenta con HIC espontánea mientras recibe un inhibidor directo del factor Xa (rivaroxabán, apixabán o edoxabán). La actividad anticoagulante persistente en el momento de la hemorragia amenaza directamente la estabilidad del hematoma y debe contrarrestarse de manera prioritaria.
- Reducción de la actividad anti–factor Xa
- Resultado hemostático excelente o bueno: aumento <35% en el volumen del hematoma a las 12 horas
References
In patients with anticoagulant-associated spontaneous ICH, anticoagulation should be discontinued immediately and rapid reversal of anticoagulation should be performed as soon as possible after diagnosis of spontaneous ICH to improve survival.
In patients with direct factor Xa inhibitor–associated spontaneous ICH, andexanet alfa is reasonable to reverse the anticoagulant effect of factor Xa inhibitors. andexanet alfa for reversal of factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban.
In patients with direct factor Xa inhibitor–associated spontaneous ICH, a 4-F PCC or activated PCC (aPCC) may be considered to improve hemostasis.
In patients with dabigatran- or factor Xa inhibitor–associated spontaneous ICH, when the DOAC agent was taken within the previous few hours, activated charcoal may be reasonable to prevent absorption of the DOAC.
In a subgroup publication of patients with factor Xa inhibitor–associated ICH, excellent or good hemostatic outcome, defined as <35% increase in hematoma volume after 12 hours, was seen in 79% of patients.
DOI: 10.1161/STR.0000000000000407
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