Tratamento da Hemorragia Intracerebral Espontânea em Pacientes em Uso de Inibidor Direto do Fator Xa
A hemorragia intracerebral espontânea em um paciente em tratamento ativo com inibidor direto do fator Xa — rivaroxabana, apixabana ou edoxabana — representa uma emergência que exige reversão imediata e estruturada da anticoagulação para limitar a expansão do hematoma.
O paciente apresenta HIC espontânea enquanto recebe inibidor direto do fator Xa (rivaroxabana, apixabana ou edoxabana). A atividade anticoagulante contínua no momento da hemorragia ameaça diretamente a estabilidade do hematoma e deve ser neutralizada com prioridade.
- Redução da atividade anti-fator Xa
- Desfecho hemostático excelente ou bom: aumento <35% no volume do hematoma em 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
View source ↗