Epidural hematoma medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*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> | *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 | **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 | ||
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== Medical therapy == | == Medical therapy == | ||
Revision as of 15:57, 6 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The mainstay of treatment for epidural hematoma is surgery.
Medical Therapy
- 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.[1][2][3][4][5]
- 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
- Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
- Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
Disease Name
- 1 Stage 1 - Name of stage
- 1.1 Specific Organ system involved 1
- 1.1.1 Adult
- Preferred regimen (1): drug name 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
- Preferred regimen (2): drug name 500 mg PO q8h for 14-21 days
- Preferred regimen (3): drug name 500 mg q12h for 14-21 days
- Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
- Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
- Alternative regimen (3): drug name 500 mg PO q6h for 14–21 days
- 1.1.2 Pediatric
- 1.1.2.1 (Specific population e.g. children < 8 years of age)
- Preferred regimen (1): drug name 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
- Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
- Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
- 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
- Preferred regimen (1): drug name 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
- Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
- 1.1.2.1 (Specific population e.g. children < 8 years of age)
- 1.1.1 Adult
- 1.2 Specific Organ system involved 2
- 1.1 Specific Organ system involved 1
- 2 Stage 2 - Name of stage
- 2.1 Specific Organ system involved 1
- Note (1):
- Note (2):
- Note (3):
- 2.1.1 Adult
- Parenteral regimen
- Oral regimen
- Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
- Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
- Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
- Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
- Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
- Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
- 2.1.2 Pediatric
- Parenteral regimen
- Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
- Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
- Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
- Oral regimen
- Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
- Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
- Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
- Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
- Parenteral regimen
- 2.2 'Other Organ system involved 2'
- Note (1):
- Note (2):
- Note (3):
- 2.2.1 Adult
- Parenteral regimen
- Oral regimen
- Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
- Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
- Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
- Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
- Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
- Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
- 2.2.2 Pediatric
- Parenteral regimen
- Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
- Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
- Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
- Oral regimen
- Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
- Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
- Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
- Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
- Parenteral regimen
- 2.1 Specific Organ system involved 1
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Medical therapy
- Anticonvulsant medications (such as phenytoin) may be used to control or prevent seizures.
- Some medications called "hyperosmotic agents" (like mannitol, glycerol, and hypertonic saline) may be used to reduce brain swelling.
References
- ↑ 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.