From the Guidelines
Aspirin reversal in intracranial hemorrhage is primarily managed by discontinuing aspirin and administering platelet transfusions, as there is no specific reversal agent available. The management of aspirin-associated intracranial hemorrhage focuses on counteracting its antiplatelet effects, which is crucial given that aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), affecting platelet function for their entire lifespan 1. Key interventions include:
- Discontinuing aspirin immediately
- Administering platelet transfusions, typically 1 unit of platelets per 10kg body weight, to replace affected platelets
- Considering desmopressin (DDAVP) at 0.3 mcg/kg IV to enhance platelet function, although its use may vary based on clinical judgment and availability The importance of rapid reversal of coagulopathy in antithrombotic-associated intracranial hemorrhage is highlighted by the increased risk of secondary hematoma expansion and poor outcomes in these patients 1. Therefore, standard management of intracranial hemorrhage, including blood pressure control, neurosurgical evaluation, and supportive care, should proceed concurrently with these specific measures to address aspirin's effects. Platelet function testing, when available, can guide therapy, but prompt intervention is essential due to the potential for transfused platelets to be inhibited by circulating aspirin.
From the Research
Reversal of Aspirin in Intracranial Hemorrhage
- The reversal of aspirin in intracranial hemorrhage is a critical aspect of managing patients who are taking antiplatelet therapy and experience bleeding in the brain.
- According to the study by 2, the Neurocritical Care Society and Society of Critical Care Medicine developed a guideline for the reversal of antithrombotics, including antiplatelet agents, in intracranial hemorrhage.
- However, the study by 3 found that platelet transfusion, which is often used to reverse platelet dysfunction in patients on preinjury antiplatelets, did not significantly reduce the risk of death, hemorrhage progression, or the need for neurosurgical intervention in patients with traumatic intracranial hemorrhage.
- Another study by 4 found that aspirin did not affect hematoma growth in severe spontaneous intracranial hematoma, suggesting that the use of aspirin may not be a significant contributor to the expansion of bleeding in the brain.
Management of Intracranial Hemorrhage
- The management of intracranial hemorrhage involves prompt recognition and initiation of urgent therapy, as well as neurosurgical consultation to pursue early surgical therapy if necessary, as discussed in the study by 5.
- The study by 6 highlights the importance of diagnosing and managing intracranial hemorrhage based on the anatomic location of bleeding and the underlying cause, such as trauma or spontaneous intraparenchymal hemorrhage.
- The use of evidence-based reversal strategies, as recommended by the guideline developed by 2, can help assist practitioners in the care of patients with antithrombotic-associated intracranial hemorrhage.