Neurochirurgie d'urgence et AVK: retarder la chirurgie n'est pas nécessaire

Intracranial bleeding (ICH) under oral anticoagulation (OAC) therapy is a dramatic event with an appalling prognosis. Guidelines recommend early reversal of OAC therapy, which should improve outcome. Clotting factors (PCC) and vitamin K remain the gold standard in ICH under OAC therapy. If the international normalized ratio (INR) at admission is not quickly available, a single 25 UI/kg (1 ml/kg) dose of PCC associated with 10 mg of vitamin K provides adequate and durable coagulation in a few minutes, without adverse events. No delay is necessary in case of surgery. As soon as the diagnosis is confirmed, OAC therapy must be reversed by the physician in charge of the patients. A postreversal INR is useful to confirm reversal. Regarding the discrepancies between the official guidelines and prescriptions in the emergency unit, education on the importance of rapid reversal of OAC therapy should be improved. Outside of the emergency situation, restarting anticoagulation should be discussed for each patient.