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Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: Executive Summary. A Statement for Healthcare Professionals From the Neurocritical Care Society and the Society of Critical Care Medicine

Frontera, Jennifer A. MD, FNCS; Lewin, John J. III PharmD, MBA, FASHP, FCCM, FNCS; Rabinstein, Alejandro A. MD, FNCS; Aisiku, Imo P. MD, MBA, FCCP; Alexandrov, Anne W. PhD, RN, ANVP-BC, FAAN; Cook, Aaron M. PharmD, BCPS; del Zoppo, Gregory J. MD, MS; Kumar, Monisha MD; Peerschke, Ellinor I. B. PhD, FAHA; Stiefel, Michael F. MD, PhD; Teitelbaum, Jeanne S. MD; Wartenberg, Katja E. MD; Zerfoss, Cindy L. MSN, RN, ACNP-BC

doi: 10.1097/CCM.0000000000002057
Special Article

1The Cerebrovascular Center, Neurological Institute, Cleveland Clinic and Case Western Reserve University, Cleveland, OH.

2The Departments of Pharmacy and Anesthesiology & Critical Care Medicine, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, MD.

3The Department of Neurology, Mayo Clinic, Rochester, MN.

4Department of Emergency Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA.

5The University of Tennessee Health Science Center, Memphis, TN.

6Australian Catholic University, Sydney, NSW, Australia.

7The Department of Pharmacy, University of Kentucky, Lexington, KY.

8The Departments of Medicine (Hematology) and Neurology, University of Washington School of Medicine, Seattle, WA.

9The Departments of Neurology, Neurosurgery, Anesthesiology & Critical Care, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

10The Department of Laboratory Medicine and Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical School, New York, NY.

11The Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY.

12Hôpital du Sacré-Coeur, Montreal, QC, Canada.

13University of Montreal and Montreal Neurological Institute and McGill University, Montreal, QC, Canada.

14Department of Neurology, Klinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.

15The Neuroscience and Neurosurgery Departments, Centra Lynchburg General Hospital, Lynchburg, VA.

The Neurocritical Care Society and Society of Critical Care Medicine affirm the value of this guideline as an educational tool for clinicians.

The American Association of Neurological Surgeons and Congress of Neurological Surgeons affirm the educational benefit of this document.

Drs. Frontera and Lewin (Guideline cochairs) contributed equally to this article.

Dr. Aisiku serves on the National Advisory Board for the Medicines Company. Dr. Lewin III disclosed other support. He serves as a consultant to the U.S. Department of Defense (Defense Advanced Research Projects Agency [January 2014 to present] for work unrelated to this publication). Dr. Rabinstein disclosed off-label product use (andexanet alfa). Dr. Alexandrov serves on the speaker’s bureau for Genentech. She has lectured for Genentech (Alteplase speakers program; reversal of alteplase, as discussed in this work, is not part of the program content). Dr. del Zoppo has received research funds from the National Institutes of Health, Boehringer Ingelheim, and Novartis. He has served on advisory boards for Boehringer Ingelheim, Daiichi-Sankyo, and Novartis. Dr. Kumar has received support from Haemonetics. Dr. Stiefel serves as a consultant for Medtronic and Penumbra. Dr. Wartenberg received funding from the Martha Maria Hospital Doelau, Halle, Germany (payment for two lectures, all unrelated to the article) and from the City Hospital of Altenburg, Germany (payment for one lecture, all unrelated to the article). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Jennifer A. Frontera, Cleveland Clinic Foundation, Cerebrovascular Center, 9500 Euclid Ave, S80 Cleveland, OH 44195. E-mail:

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