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Direct-Acting Oral Anticoagulants and Warfarin-Associated Intracerebral Hemorrhage Protocol Reduces Timing of Door to Correction Interventions

Olivier, Rosemary C.; Gleeson, Diane; Skinner, Claudia; Cacciata, Marysol; Wickman, Mary

Journal of Neuroscience Nursing: April 2019 - Volume 51 - Issue 2 - p 89–94
doi: 10.1097/JNN.0000000000000430

ABSTRACT Background: Intracerebral hemorrhage (ICH) is a life-threatening complication of oral anticoagulant therapy that sometimes results in hematoma expansion after onset. Our facility did not have a standardized process for treating oral anticoagulant–associated ICH; this resulted in lag times from order to reversal agent administration. Purpose: The aim of this study was to examine the impact of a rapid anticoagulant reversal protocol, combined with warfarin and direct-acting oral anticoagulant therapy, in decreasing door to first intervention times. Methods: This study used a retrospective quality assessment research approach in examining an oral anticoagulant reversal protocol to compare the control and intervention groups. Phytonadione was the first intervention treatment for most study participants diagnosed with warfarin-associated ICH with an international normalized ratio greater than 1.4. Factor IX was the first intervention treatment for all but one study participant with DOAC-associated ICH. Results: Findings were statistically significant (P < .05) for door to first intervention treatments. Door to phytonadione in minutes decreased from 232.7 (SD, 199.4) to posttest findings of 111.4 (SD, 64.6). Door to factor IX in minutes decreased from 183.9 (SD, 230.2) to posttest findings of 116.6 (SD, 69.1). Conclusion: Study findings support the hypothesis that the new protocol was associated with lower door-to-treatment times for eligible patients.

Questions or comments about this article may be directed to Rosemary C. Olivier, MSN RN CCRN SCRN, at She is a Critical Care Nurse Leader, St Jude Medical Center, Fullerton, CA.

Diane Gleeson, MSN ANP-BC, is Neurology Nurse Practitioner, St Jude Medical Center, Fullerton, CA.

Claudia Skinner, DNP RN CIC CCRN-K NE-BC FAPIC, is Director, Center of Excellence, St Jude Medical Center, Fullerton, CA.

Marysol Cacciata, MSN RN CCRN-K, is Research Coordinator, St Jude Medical Center, Fullerton, CA.

Mary Wickman, PhD RN, is Professor and Director, Nursing, Vanguard University, Costa Mesa, CA.

The authors declare no conflicts of interest.

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© 2019 American Association of Neuroscience Nurses