Epidural hematoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The mainstay of treatment for epidural hematoma is urgent surgery.
Medical Therapy
- The mainstay of treatment for epidural hematoma is urgent surgery.[1]
- 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.[2][3][4][5][6]
- 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
References
- ↑ Maugeri R, Anderson DG, Graziano F, Meccio F, Visocchi M, Iacopino DG (2015). "Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature". Am J Case Rep. 16: 811–7. PMC 4652627. PMID 26567227.
- ↑ 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.