Intracerebral haemorrhage on oral anticoagulants and adherence to reversal guidelines

McCartney-Patel, N, Marigold, R, Weir, N., P, Crawford, Evans, S., Battersby Wood, E. and Siddegowda, S. (2018) Intracerebral haemorrhage on oral anticoagulants and adherence to reversal guidelines. International Journal of Stroke, 14 (4S), 36. (doi:10.1177/1747493019882907).

Abstract

Introduction: 15% of acute stroke patients suffer an intracerebral haemorrhage (ICH) and up to 20% of patients are on anticoagulation namely warfarin or direct oral anticoagulants (DOACs). Early haemostatic treatment limits haematoma size and growth and this is reflected in recently updated NICE
guidelines which highlight the need for emergency treatment to improve prognosis.

Method: A retrospective audit was performed to assess the proportion of patients presenting with intracerebral haemorrhage on anticoagulation, and if so, to assess whether timely reversal agents were administered.

Results: 17/137 patients with intracerebral haemorrhage were on anticoagulation. 16/17 patients were given a reversal agent but only 12/17 were given both vitamin K and octaplex. These findings represent
an 82% adherence to national guidelines.

Conclusion: Further data and a trustwide audit which include more recent guidance in reversing DOACs are needed to improve performance and outcomes in acute intracerebral haemorrhage.

A new departmental guideline for ICH has been finalised and the intention is to use this to benchmark future audit against national standards.

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