22307_DOACs_and Intracranial_Hemorrhage

In this program, Program Chair Dr. Joshua Goldstein and an expert multidisciplinary faculty (Dr. Casey May, Dr. Anne Alexandrov, and Dr. Ashkan Shoamanesh) will provide attendees with best practices for optimal management of intracranial hemorrhage.

Direct oral anticoagulants (DOACs) have become widely used for the prevention and treatment of venous thromboembolism, stroke prevention in atrial fibrillation, and management of patients with coronary artery disease or peripheral artery disease. Large clinical trials have demonstrated that DOACs are as effective and safer than warfarin and are now widely recommended by guidelines. Despite their superior safety, a small percentage of patients suffer intracranial hemorrhage, which is associated with 30-day mortality rates approaching 50%. Specific agents that reverse anticoagulation with factor Xa inhibition and with oral direct thrombin inhibition have demonstrated effectiveness in clinical trials and are now preferred therapies in guidelines and statements from the American Heart Association/American Stroke Association (endorsed by multiple societies including the Neurocritical Care Society) and the American College of Cardiology Expert Consensus Decision Pathway. There is a lack of clinician awareness of prudent initial interventions for intracranial hemorrhage, clinical profiles of reversal agents, and guideline recommendations for reversal of anticoagulants. Intracranial hemorrhage is a complex clinical event that has been shown to benefit from specially trained, multidisciplinary care; a multidisciplinary team is recommended in clinical practice guidelines to improve outcomes and reduce mortality. Therefore, in this program, Program Chair Dr. Joshua Goldstein and an expert multidisciplinary faculty (Dr. Casey May, Dr. Anne Alexandrov, and Dr. Ashkan Shoamanesh) will provide attendees with best practices for optimal management of intracranial hemorrhage.

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