Neurológia pre prax 2/2014

Intracerebral hemorrhage and anticoagulation therapy

Anticoagulation therapy is being used in the prevention and therapy of thrombosis and thromboembolism and of related complications, including the prevention of ischemic stroke. Warfarin, heparin (including low-molecular-weight one), but also new oral anticoagulants (e. g. dabigatran, rivaroxaban or apixaban) are being used most frequently for this purpose. The use of anticoagulants may be complicated by hemorrhage, including spontaneous intracerebral hemorrhage (SICH). In the case of the occurrence of SICH in patient on oral anticoagulation, immediate discontinuation of anticoagulation and effort for the most rapid normalization of coagulation parameters are indicated. During decision making about the indication of long-term anticoagulation in the secondary prevention of stroke in patients with a history of SICH, comparison of the risk of SICH recurrence and the risk of ischemic vascular disease is needed.

Keywords: intracerebral hemorrhage, anticoagulant therapy, warfarin, new oral anticoagulants, ischemic stroke, prevention.