Outcome following intracranial hemorrhage associated with novel oral anticoagulants

The emergence of dabigatran, rivaroxaban and apixaban has changed the approach to anticoagulation for patients worldwide. Continued approval of novel oral anticoagulants (NOAC) for non-valvular atrial fibrillation and venous thromboembolism will result in increasing use of these medications over warfarin. Morbidity and mortality of anticoagulant related intracranial hemorrhage (ICH) is relatively high and there is concern that outcomes may be worse with NOAC as there is a lack of specific antidotes for these agents with a greater risk for hematoma expansion. Unfortunately, the evidence supporting effective reversal strategies is lacking. Therefore, to gain further insight into the outcome after the management of NOAC related ICH, we present our experience with two patients with NOAC-induced ICH.