Evidence map›Paper›PMID 42786382›Full record

ArticleNeurocritical care2026

Treatment of Antithrombotic-Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update from the Neurocritical Care Society and the Society of Critical Care Medicine.

Meghan Caylor Vallejo, Lori S Kennedy, Bradley Dengler, Colleen Barthol, Emilie P Belley-Cote, Joseph D Burns, Veda K Chau, Charlotte Cordonnier, Adam Cuker, Kimia Honarmand and 3 more

Abstract read
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Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Meghan Caylor VallejoDepartment of Pharmacy, Temple University Hospital, Philadelphia, PA, USA. mmcaylor@gmail.com.ORCID http://orcid.org/0000-0002-8164-8145
Lori S KennedyCenter for Nursing Science, UC Davis Health, Sacramento, CA, USA.
Bradley DenglerMilitary Traumatic Brain Injury Initiative, Uniformed Services University, Bethesda, MD, USA.
Colleen BartholDepartment of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA.
Emilie P Belley-CoteDepartment of Medicine, Divisions of Cardiology and Critical Care, McMaster University, Hamilton, ON, Canada.
Joseph D BurnsDivision of Neurology, Section of Neurocritical Care, Lahey Hospital and Medical Center, Burlington, MA, USA.
Veda K ChauStanford Health Care, Neurocritical Care, Palo Alto, CA, USA.
Charlotte CordonnierUniversity of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France.
Adam CukerDepartment of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Kimia HonarmandDivision of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, Canada.
Sherif Hanafy MahmoudFaculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
M Elizabeth WilcoxDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Monisha A KumarDepartments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, PA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntithrombotic-associated intracranial hemorrhage (ICH) is a life-threatening condition, and rapid treatment in the setting of antithrombotic agents may limit hematoma expansion and improve outcomes. This focused update evaluated the available evidence after publication of the 2016 guidelines.

methodsThe Neurocritical Care Society, in conjunction with the Society of Critical Care Medicine, generated five questions to guide a systematic review and meta-analysis. Three of these questions update prior recommendations, while two are newly introduced. Each question followed a Population, Intervention, Comparator, Outcome (PICO) framework and focused on the management of acute ICH including spontaneous intraparenchymal hemorrhage (IPH) and traumatic ICH. The topics addressed were: (1) andexanet alfa versus 4-factor prothrombin complex concentrate (4F-PCC) for treatment of oral factor Xa inhibitor effects; (2) platelet transfusion versus no transfusion for treatment in the setting of antiplatelet agent use; (3) desmopressin versus no desmopressin for treatment in the setting of antiplatelet agent use; (4) treatment of anticoagulant effects versus no treatment in the setting of small IPH; and (5) use of viscoelastic hemostatic assays (VHAs) to treat coagulopathy in traumatic ICH. Recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.

resultsThe panel generated eight recommendations. For patients with acute ICH, the panel issued the following conditional recommendations: use 4F-PCC rather than andexanet alfa for the treatment of the anticoagulant effects of factor Xa inhibitors, avoid platelet transfusion in non-neurosurgical patients with spontaneous IPH on antiplatelet agents, administer platelet transfusion in patients with spontaneous IPH on aspirin who are undergoing surgery, and use VHAs to guide treatment of coagulopathy in traumatic ICH. The panel was unable to issue recommendations regarding platelet transfusion for treatment of antiplatelet effects in traumatic ICH, use of desmopressin for treatment of antiplatelet effects, or treatment of anticoagulant effects in small IPH.

conclusionsThe guideline writing panel provided new conditional recommendations for the treatment of antithrombotic-associated acute ICH. These recommendations are intended for consideration along with the patient's clinical status and patient-specific factors.

Indexed as

AnticoagulantAntidoteAntiplateletAntithromboticApixabanAspirinBlood productsClopidogrelDDAVPDesmopressinEvidence-based medicineFactor Xa inhibitorGRADE criteria, guidelinesGrading of Recommendations Assessment, Development, and Evaluation criteriaICHIntracerebral hemorrhageIntracranial hemorrhageIntraparenchymal hemorrhagePCCPlateletsProthrombin complex concentratesReversalRivaroxabanSAHSDHSubarachnoid hemorrhageSubdural hematomaThromboelastographyTraumatic brain injuryViscoelastic hemostatic assays

Identifiers

PMID42786382

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.