Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-Case Study Discussion 4

Video Transcription

Video Summary

This video transcript discusses a case of a 66-year-old woman who fell and developed a left parietal subdural hematoma. The patient was on apixaban for atrial fibrillation but had a higher anti-10A level than normal, indicating a more intense anticoagulation response. The decision was made to monitor the patient without acute treatment for the hematoma. However, a repeat CT showed an increase in the volume of the hematoma, prompting treatment with a four-factor prothrombin complex concentrate. The patient's anti-10A level decreased significantly after treatment. The transcript also discusses guidelines for reversing anticoagulation in patients with intracranial hemorrhage due to direct oral anticoagulants. For patients taking warfarin, prothrombin complex concentrates are recommended, while for patients taking dabigatran, the specific antibody adaricizumab should be used if available. Factor Xa inhibitors such as rivaroxaban and apixaban can be reversed with factor X, and prothrombin complex concentrates can also be used if the specific reversal agent is not available. The transcript emphasizes the importance of prompt reversal in patients with intracranial hemorrhage to prevent worsening bleeding and improve outcomes. Overall, the transcript provides valuable information about the management of anticoagulation-related intracranial hemorrhage.

Asset Caption

Andrew M Naidech (ICH Case); Jonathan E. Sevransky, MD, MHS, FCCM (AKI Case); Stephen M. Pastores MD, MACP, FCCP, FCCM (Sepsis)

Keywords

66-year-old woman

parietal subdural hematoma

apixaban

anti-10A level

prothrombin complex concentrate

intracranial hemorrhage

direct oral anticoagulants

reversal agent

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