Table 1

New and Updated Recommendations on Management of Spontaneous Intracerebral Hemorrhage3,a

Therapeutic IssueRecommendationCORbLOEbType of Recommendation
Dabigatran reversalHemodialysis may be consideredIIbCNew
Direct oral anticoagulant reversalAnti-inhibitor coagulant complex (Feiba, Baxter Healthcare), PCCs, or rFVIIa may be considered along with administration of activated charcoal for recent doses (e.g., within 2 hr)IIbCNew
Heparin reversalProtamine may be consideredIIbCNew
Vitamin K antagonist reversalPCCs may be considered as alternative to FFPIIbBUpdate
rFVIIa not recommendedIIICUpdate
Timing of anticoagulation resumptionOptimal timing unknown; should be avoided for at least 4 wk (unless patient has mechanical heart valve)IIbBNew
Timing of aspirin therapyOptimal timing uncertain; may be restarted within daysIIaBNew
Direct oral anticoagulant therapy for AFUsefulness uncertainIIbCNew
  • a COR = classification of recommendation, LOE = level of evidence, PCC = prothrombin complex concentrate, rVIIa = recombinant activated factor VII, FFP = fresh frozen plasma, AF = atrial fibrillation.

  • b Definitions of levels of classification and evidence provided in guideline summary.