Table 1 Reversal therapies in anticoagulant-associated intracerebral hemorrhage

Vitamin K antagonists

Warfarin

Vitamin K

10 mg IV

Anaphylaxis

INR

FFP

4 U or 12 ml/kg IV

Fluid overload

PCCs

If INR 1.7–4, give 25 U/kg; if INR 4–6, give 35 U/kg; if INR > 6, give 50 U/kg. (targeting INR level < 1.3 within 4 h)

Thrombotic events

Direct thrombin inhibitors

Dabigatran

Idarucizumab

Preferred drug

Single 5 g/100 ml dose, repeat if needed

Headaches

APTT, TT

Medicinal activated charcoal

50 g if DOACs are ingested < 2 h

-

Direct factor Xa inhibitors

Apixaban; Betrixaban; Edoxaban; Rivaroxaban

Andexanet alfa

Preferred drug

800 mg bolus over 30 min, then 960 mg over 2 h if the last intake ≤ 7 h; 400 mg bolus over 15 min, then 480 mg over 2 h if the last intake > 7 h

Thrombotic events

Anti-Xa activity

4-factor PCC

50 IU/kg IV (off-label)

Thrombotic events

Medicinal activated charcoal

50 g if DOACs are ingested < 2 h

-

Heparinoids

UFH

Protamine sulfate

1 mg IV for every 100 U of heparin given in the previous 3 h (up to 50 mg in a single dose)

Bradycardia, hypotension

APTT, Anti-Xa activity