Therefore, thrombosis is blocked through the inactivation of activated Factor X and inhibition of prothrombin’s conversion to thrombin. 1, 2 Heparin will potentiate the action of antithrombin III and thereby inactivates thrombin (as well as activated coagulation factors IX, X, XI, XII, and plasmin) and prevents the conversion of fibrinogen to fibrin. Table 1 reviews those agents that indirectly affect thrombin (generally through antithrombin) and include drugs such as the heparinoids and their reversal agents. The levels of evidence offered are based on the University of Wisconsin Health Care (UWHC) Guidelines that follow criteria used by the American College of Cardiology and the American Heart Association (ACC/AHA). By design, the text has been kept to a minimum, and the tables made succinct to most practically present the relevant information. It documents: (a) the duration of action of the offending agent or condition (b) the treatment (c) the half-life of the treatment and (d) the laboratory tests needed (if available) to follow the reversal of the coagulopathy.
It is compiled into nine tables that are organized by the mechanism of coagulopathy. This technical note is a comprehensive overview of the medications and conditions that can lead to persistent (or initiation of) life-threatening intracranial hemorrhage.
#ANTIDOTE FOR ALTEPLASE HOW TO#
When faced with a life-threatening coagulopathy, neurosurgeons and neurologists may not have ready access to information about the drug or condition that caused the coagulopathy or the information on how to treat it. These newer agents not only broaden the store of knowledge required to treat these patients, but they also make it more difficult to achieve an effective reversal with each new generation of drugs that arrive on the market. That said, knowing how to medically correct a coagulopathy has become increasingly challenging as more contemporary and sophisticated anticoagulation agents are developed and prescribed.
Recognizing the vital anatomy inherent to the central nervous system, one could argue that neurologists and neurosurgeons, above any other medical subspecialists, need to understand how to effectively stop life-threatening hemorrhage.
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