Medical Treatment for Spontaneous Anticoagulation-Related Intracerebral Hemorrhage in the Netherlands

J Stroke Cerebrovasc Dis. 2017 Jul;26(7):1427-1432. doi: 10.1016/j.jstrokecerebrovasdis.2017.03.019. Epub 2017 Apr 12.


Background: Spontaneous anticoagulation-related intracerebral hemorrhage accounts for up to a quarter of spontaneous intracerebral hemorrhage cases and is associated with higher hematoma volume and a worse outcome. Guidelines recommend rapid anticoagulant reversal but mode and timing are not specified and optimal strategy is uncertain. Variability in everyday practice is unknown.

Methods: An invitation to a web-based survey was sent to 85 Dutch stroke neurologists in different hospitals, with questions about importance, timing, and medical management of spontaneous anticoagulation-related intracerebral hemorrhage.

Results: In total, 61 (72%) neurologists completed the survey. Nearly all (97%) deemed rapid anticoagulant reversal important. A local guideline for management of anticoagulant reversal was used in 80% of the hospitals. Most neurologists (56%) estimated anticoagulant reversal in anticoagulation-related intracerebral hemorrhage to start later than intravenous thrombolysis in ischemic stroke. Few (5%) thought it was quicker. A minority (28%) of the hospitals started anticoagulation reversal without waiting for laboratory test results or consulting a specialist in hemostasis. Prothrombin complex concentrate was used by all neurologists for vitamin K antagonist reversal and by most (74%) for reversal of thrombin inhibitors and factor Xa inhibitors (72%). Anticoagulation reversal was initiated at the emergency department according to 89% of the respondents.

Conclusion: Variability in logistics in acute management of spontaneous anticoagulation-related intracerebral hemorrhage was demonstrated. Anticoagulant reversal is deemed important, but is estimated to have a longer door-to-needle time than alteplase in thrombolysis for ischemic stroke by most neurologists. Several delaying factors were found. These factors might have an impact on outcome.

Keywords: Anticoagulation-related intracerebral hemorrhage; anticoagulation reversal; coagulopathy; door to reversal; intracerebral hemorrhage; oral anticoagulants.

MeSH terms

  • Anticoagulants / adverse effects*
  • Blood Coagulation / drug effects*
  • Blood Coagulation Tests
  • Cerebral Hemorrhage / blood
  • Cerebral Hemorrhage / chemically induced
  • Cerebral Hemorrhage / diagnosis
  • Cerebral Hemorrhage / drug therapy*
  • Coagulants / administration & dosage*
  • Coagulants / adverse effects
  • Drug Administration Schedule
  • Health Care Surveys
  • Healthcare Disparities
  • Humans
  • Netherlands
  • Plasmapheresis / adverse effects
  • Practice Patterns, Physicians'
  • Predictive Value of Tests
  • Risk Factors
  • Time-to-Treatment
  • Treatment Outcome


  • Anticoagulants
  • Coagulants