Template:ICH Coagulopathy Guidelines - Revision history

Luca.ratibondi: /* AHA ICH Coagulopathy Guidelines 2015Hemphill JC, et al. AHA/ASA Guideline: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Associatio...

2020-12-27T23:05:55Z

/* AHA ICH Coagulopathy Guidelines 2015Hemphill JC, et al. AHA/ASA Guideline: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Associatio...

← Older revision		Revision as of 23:05, 27 December 2020
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	# Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence C). (Unchanged from the previous guideline)		# Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence C). (Unchanged from the previous guideline)
	# Patients with ICH whose INR is elevated because of VKA should have their VKA withheld, receive therapy to replace vitamin K–dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence C). PCCs may have fewer complications and correct the INR more rapidly than FFP and might be considered over FFP (Class IIb; Level of Evidence B). rFVIIa does not replace all clotting factors, and although the INR may be lowered, clotting may not be restored in vivo; therefore, rFVIIa is not recommended for VKA reversal in ICH (Class III; Level of Evidence C). (Revised from the previous guideline)		# Patients with ICH whose INR is elevated because of VKA should have their VKA withheld, receive therapy to replace vitamin K–dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence C). PCCs may have fewer complications and correct the INR more rapidly than FFP and might be considered over FFP (Class IIb; Level of Evidence B). rFVIIa does not replace all clotting factors, and although the INR may be lowered, clotting may not be restored in vivo; therefore, rFVIIa is not recommended for VKA reversal in ICH (Class III; Level of Evidence C). (Revised from the previous guideline)
	#For patients with ICH who are taking dabigatran, rivaroxaban, or apixaban, treatment with FEIBA, other PCCs, or rFVIIa might be considered on an individual basis. Activated charcoal might be used if the most recent dose of dabigatran, apixaban, or ~~riva- roxaban~~ was taken <2 hours earlier. Hemodialysis might be considered for dabigatran (Class IIb; Level of Evidence C). (New recommendation)		#For patients with ICH who are taking dabigatran, rivaroxaban, or apixaban, treatment with FEIBA, other PCCs, or rFVIIa might be considered on an individual basis. Activated charcoal might be used if the most recent dose of dabigatran, apixaban, or rivaroxaban was taken <2 hours earlier. Hemodialysis might be considered for dabigatran (Class IIb; Level of Evidence C). (New recommendation)
	# Protamine sulfate may be considered to reverse ~~hep- arin~~ in patients with acute ICH (Class IIb; Level of Evidence C). (New recommendation)		# Protamine sulfate may be considered to reverse heparin in patients with acute ICH (Class IIb; Level of Evidence C). (New recommendation)
	# The usefulness of platelet transfusions in ICH patients with a history of antiplatelet use is ~~uncer- tain~~ (Class IIb; Level of Evidence C). (Revised from the previous guideline)		# The usefulness of platelet transfusions in ICH patients with a history of antiplatelet use is uncertain (Class IIb; Level of Evidence C). (Revised from the previous guideline)
	# Although rFVIIa can limit the extent of hematoma expansion in noncoagulopathic ICH patients, there is an increase in thromboembolic risk with rFVIIa and no clear clinical benefit in unselected patients. Thus, rFVIIa is not recommended (Class III; Level of Evidence A). (Unchanged from the previous guideline)		# Although rFVIIa can limit the extent of hematoma expansion in noncoagulopathic ICH patients, there is an increase in thromboembolic risk with rFVIIa and no clear clinical benefit in unselected patients. Thus, rFVIIa is not recommended (Class III; Level of Evidence A). (Unchanged from the previous guideline)

Kurtucla05: updated spontaneous ICH coagulopathy guidelines with reference

2015-08-11T16:23:51Z

updated spontaneous ICH coagulopathy guidelines with reference

← Older revision		Revision as of 16:23, 11 August 2015
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	===AHA ICH Coagulopathy Guidelines<ref>Hemphill JC, et al. AHA/ASA ~~2015~~ Guidelines for the Management of		===AHA ICH Coagulopathy Guidelines 2015<ref>Hemphill JC, et al. AHA/ASA Guideline: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015.</ref>===
	Spontaneous Intracerebral Hemorrhage. Stroke 2015.</ref>===
	# Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence C). (Unchanged from the previous guideline)		# Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence C). (Unchanged from the previous guideline)
	# Patients with ICH whose INR is elevated because of VKA should have their VKA withheld, receive therapy to replace vitamin K–dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence C). PCCs may have fewer complications and correct the INR more rapidly than FFP and might be considered over FFP (Class IIb; Level of Evidence B). rFVIIa does not replace all clotting factors, and although the INR may be lowered, clotting may not be restored in vivo; therefore, rFVIIa is not recommended for VKA reversal in ICH (Class III; Level of Evidence C). (Revised from the previous guideline)		# Patients with ICH whose INR is elevated because of VKA should have their VKA withheld, receive therapy to replace vitamin K–dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence C). PCCs may have fewer complications and correct the INR more rapidly than FFP and might be considered over FFP (Class IIb; Level of Evidence B). rFVIIa does not replace all clotting factors, and although the INR may be lowered, clotting may not be restored in vivo; therefore, rFVIIa is not recommended for VKA reversal in ICH (Class III; Level of Evidence C). (Revised from the previous guideline)

Kurtucla05: /* AHA ICH Coagulopathy GuidelinesMorgenstern, L. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke 2010;41;210...

2015-08-11T16:05:07Z

/* AHA ICH Coagulopathy GuidelinesMorgenstern, L. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke 2010;41;210...

← Older revision		Revision as of 16:05, 11 August 2015
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	===AHA ICH Coagulopathy Guidelines<ref>~~Morgenstern~~, L. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage~~: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association~~ Stroke ~~2010;41;2108-2129 [http://bit~~.~~ly/ahaichguide PDF]~~</ref>===		===AHA ICH Coagulopathy Guidelines<ref>Hemphill JC, et al. AHA/ASA 2015 Guidelines for the Management of
	#"Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence: C)"		Spontaneous Intracerebral Hemorrhage. Stroke 2015.</ref>===
	#ICH ~~and [[Warfarin (Coumadin) Reversal\|elevated~~ INR is elevated ~~due to warfarin]]~~ should have ~~warfarin held and~~ receive ~~replacement of~~ vitamin K–dependent factors and intravenous vitamin K (Class I; Level of Evidence: C).		# Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence C). (Unchanged from the previous guideline)
	~~#Prothrombin Complex Concetrates (~~PCCs~~) have not shown improved outcome compared with FFP but~~ may have fewer complications ~~compared with~~ FFP and ~~are reasonable to consider as an alternative to~~ FFP (Class ~~IIa~~; Level of Evidence: B).		# Patients with ICH whose INR is elevated because of VKA should have their VKA withheld, receive therapy to replace vitamin K–dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence C). PCCs may have fewer complications and correct the INR more rapidly than FFP and might be considered over FFP (Class IIb; Level of Evidence B). rFVIIa does not replace all clotting factors, and although the INR may be lowered, clotting may not be restored in vivo; therefore, rFVIIa is not recommended for VKA reversal in ICH (Class III; Level of Evidence C). (Revised from the previous guideline)
	#rFVIIa does not replace all clotting factors, and although the INR may be lowered it may not ~~affect clotting proportionately.~~ rFVIIa is not ~~routinely~~ recommended ~~as a sole agent~~ for reversal in ICH (Class III; Level of Evidence: C).		#For patients with ICH who are taking dabigatran, rivaroxaban, or apixaban, treatment with FEIBA, other PCCs, or rFVIIa might be considered on an individual basis. Activated charcoal might be used if the most recent dose of dabigatran, apixaban, or riva- roxaban was taken <2 hours earlier. Hemodialysis might be considered for dabigatran (Class IIb; Level of Evidence C). (New recommendation)
	#"The usefulness of platelet transfusions in ICH patients with a history of antiplatelet use is ~~unclear~~ and is ~~considered investigational~~ (Class ~~IIb~~; Level of Evidence~~: B~~)."		# Protamine sulfate may be considered to reverse hep- arin in patients with acute ICH (Class IIb; Level of Evidence C). (New recommendation)
			# The usefulness of platelet transfusions in ICH patients with a history of antiplatelet use is uncer- tain (Class IIb; Level of Evidence C). (Revised from the previous guideline)
			# Although rFVIIa can limit the extent of hematoma expansion in noncoagulopathic ICH patients, there is an increase in thromboembolic risk with rFVIIa and no clear clinical benefit in unselected patients. Thus, rFVIIa is not recommended (Class III; Level of Evidence A). (Unchanged from the previous guideline)

Ostermayer: Created page with "===AHA ICH Coagulopathy GuidelinesMorgenstern, L. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals ..."

2014-05-13T16:44:44Z

Created page with "===AHA ICH Coagulopathy Guidelines<ref>Morgenstern, L. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals ..."

New page

===AHA ICH Coagulopathy Guidelines<ref>Morgenstern, L. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke 2010;41;2108-2129 [http://bit.ly/ahaichguide PDF]</ref>===
#"Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I; Level of Evidence: C)"
#ICH and [[Warfarin (Coumadin) Reversal|elevated INR is elevated due to warfarin]] should have warfarin held and receive replacement of vitamin K–dependent factors and intravenous vitamin K (Class I; Level of Evidence: C).
#Prothrombin Complex Concetrates (PCCs) have not shown improved outcome compared with FFP but may have fewer complications compared with FFP and are reasonable to consider as an alternative to FFP (Class IIa; Level of Evidence: B).
#rFVIIa does not replace all clotting factors, and although the INR may be lowered it may not affect clotting proportionately. rFVIIa is not routinely recommended as a sole agent for reversal in ICH (Class III; Level of Evidence: C).
#"The usefulness of platelet transfusions in ICH patients with a history of antiplatelet use is unclear and is considered investigational (Class IIb; Level of Evidence: B)."