[Correction of the effect of vitamin K antagonists and antiplatelet agents in hemorrhagic stroke].

Abstract

Background: Hemorrhagic stroke (HS) is associated with high risk of mortality or disability. To date, up to 25% of HSs are associated with anticoagulants and antiplatelet agents. Early hemostatic therapy and correction of effect of antithrombotic drugs in patients with HS significantly reduce the risk of adverse outcomes. The latest international guidelines on this issue were presented almost 10 years ago.

Material and methods: In accordance with the PRISMA recommendations, we reviewed the PubMed, eLibrary and UpToDate databases and identified 137 articles. Of these, 52 were enrolled as the most relevant.

Results and discussion: Regarding correction of the effect of indirect anticoagulants, various researchers discuss the possibility of either individual dosing or injection of a fixed dose of 4- or 3-factor prothrombin complex (1000-2000 IU regardless of body weight and international normalized ratio). To correct the effect of antiplatelet agents, platelet transfusion and desmopressin are proposed. There is currently no evidence of safety and effectiveness of both methods in patients with HS.

Conclusion: The optimal drug for correction of the effect of indirect anticoagulants is 4- or 3-factor prothrombin complex. In the last case, it is necessary to administer factor VIIa or fresh frozen plasma, as well as parenteral form of phytomenadione (vitamin K₁) in all cases. The issue of correction of the effects of antiplatelet agents remains open. Regular analysis of available data with updating the guidelines for correction of the effect of anticoagulants and antiplatelet agents in HS is necessary.