Epidural hematoma medical therapy: Difference between revisions
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{{Epidural hematoma}} | {{Epidural hematoma}} | ||
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==Overview== | |||
The mainstay of treatment for epidural hematoma is urgent surgery. | |||
== | ==Medical Therapy== | ||
*The mainstay of treatment for epidural hematoma is urgent surgery.<ref name="pmid26567227">{{cite journal| author=Maugeri R, Anderson DG, Graziano F, Meccio F, Visocchi M, Iacopino DG| title=Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature. | journal=Am J Case Rep | year= 2015 | volume= 16 | issue= | pages= 811-7 | pmid=26567227 | doi= | pmc=4652627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26567227 }} </ref> | |||
*In patients with uncontrolled or life-threatening [[bleeding]] (such as progressive epidural hematoma); who are taking [[apixaban]] or [[rivaroxaban]], reversal of [[Anticoagulant|anti-coagulation]] may be done by Andexanet alfa.<ref name="pmid23455714">{{cite journal| author=Lu G, DeGuzman FR, Hollenbach SJ, Karbarz MJ, Abe K, Lee G et al.| title=A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. | journal=Nat Med | year= 2013 | volume= 19 | issue= 4 | pages= 446-51 | pmid=23455714 | doi=10.1038/nm.3102 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23455714 }} </ref><ref name="pmid27573206">{{cite journal| author=Connolly SJ, Milling TJ, Eikelboom JW, Gibson CM, Curnutte JT, Gold A et al.| title=Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 12 | pages= 1131-41 | pmid=27573206 | doi=10.1056/NEJMoa1607887 | pmc=5568772 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27573206 }} </ref><ref name="pmid28282497">{{cite journal| author=Nafee T, Aslam A, Chi G, Pahlavani S, Nimri D, Kuchkuntla AR et al.| title=Andexanet alfa for the reversal of anticoagulant activity in patients treated with direct and indirect factor Xa inhibitors. | journal=Expert Rev Cardiovasc Ther | year= 2017 | volume= 15 | issue= 4 | pages= 237-245 | pmid=28282497 | doi=10.1080/14779072.2017.1305889 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28282497 }} </ref><ref name="pmid28002711">{{cite journal| author=Connolly SJ, Gibson CM, Crowther M| title=Andexanet Alfa for Factor Xa Inhibitor Reversal. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 25 | pages= 2499-500 | pmid=28002711 | doi=10.1056/NEJMc1613270 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28002711 }} </ref><ref name="pmid29590221">{{cite journal| author=Lu G, Pine P, Leeds JM, DeGuzman F, Pratikhya P, Lin J et al.| title=Andexanet alfa effectively reverses edoxaban anticoagulation effects and associated bleeding in a rabbit acute hemorrhage model. | journal=PLoS One | year= 2018 | volume= 13 | issue= 3 | pages= e0195122 | pmid=29590221 | doi=10.1371/journal.pone.0195122 | pmc=5874076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29590221 }} </ref> | |||
**Andexanet alfa Dosing Regimens: '''Low dose''': 400 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute IV infusion for up to 120 minutes '''High dose''': 800 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute IV infusion for up to 120 minutes | |||
==References== | |||
{{Reflist|2}} | |||
== References == | |||
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Latest revision as of 16:17, 6 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The mainstay of treatment for epidural hematoma is urgent surgery.
Medical Therapy
- The mainstay of treatment for epidural hematoma is urgent surgery.[1]
- In patients with uncontrolled or life-threatening bleeding (such as progressive epidural hematoma); who are taking apixaban or rivaroxaban, reversal of anti-coagulation may be done by Andexanet alfa.[2][3][4][5][6]
- Andexanet alfa Dosing Regimens: Low dose: 400 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute IV infusion for up to 120 minutes High dose: 800 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute IV infusion for up to 120 minutes
References
- ↑ Maugeri R, Anderson DG, Graziano F, Meccio F, Visocchi M, Iacopino DG (2015). "Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature". Am J Case Rep. 16: 811–7. PMC 4652627. PMID 26567227.
- ↑ Lu G, DeGuzman FR, Hollenbach SJ, Karbarz MJ, Abe K, Lee G; et al. (2013). "A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa". Nat Med. 19 (4): 446–51. doi:10.1038/nm.3102. PMID 23455714.
- ↑ Connolly SJ, Milling TJ, Eikelboom JW, Gibson CM, Curnutte JT, Gold A; et al. (2016). "Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors". N Engl J Med. 375 (12): 1131–41. doi:10.1056/NEJMoa1607887. PMC 5568772. PMID 27573206.
- ↑ Nafee T, Aslam A, Chi G, Pahlavani S, Nimri D, Kuchkuntla AR; et al. (2017). "Andexanet alfa for the reversal of anticoagulant activity in patients treated with direct and indirect factor Xa inhibitors". Expert Rev Cardiovasc Ther. 15 (4): 237–245. doi:10.1080/14779072.2017.1305889. PMID 28282497.
- ↑ Connolly SJ, Gibson CM, Crowther M (2016). "Andexanet Alfa for Factor Xa Inhibitor Reversal". N Engl J Med. 375 (25): 2499–500. doi:10.1056/NEJMc1613270. PMID 28002711.
- ↑ Lu G, Pine P, Leeds JM, DeGuzman F, Pratikhya P, Lin J; et al. (2018). "Andexanet alfa effectively reverses edoxaban anticoagulation effects and associated bleeding in a rabbit acute hemorrhage model". PLoS One. 13 (3): e0195122. doi:10.1371/journal.pone.0195122. PMC 5874076. PMID 29590221.