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New and groundbreaking therapeutic options for the critical care of patients with cerebrovascular disease have improved patient management, minimized morbidity, reduced in-patient care, improved quality of life, and had a positive economic impact on health service provision. This volume integrates these approaches and suggests the best therapy option for all cerebrovascular conditions. The early chapters of the book focus on monitoring techniques and interventions. Subsequent sections address the critical care of a wide range of cerebrovascular diseases: ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, arteriovenous malformations, cerebral venous thrombosis and traumatic injury. The editors and authors are internationally recognized experts in their field, and the text is supplemented by tables and illustrations to demonstrate important clinical findings. This book will meet the needs of stroke physicians, neurologists, neurosurgeons, neurointensivists and interventional neuroradiologists seeking to maximize positive outcomes for their patients.
This chapter focuses on the epidemiology of oral anticoagulant therapy (OAT)-associated ICH, its pathophysiology, and treatment options based on the currently available data. One of the most common indications for OAT is to prevent stroke in patients with atrial fibrillation. Intracerebral hemorrhage is the deadliest form of stroke, with a mortality rate between 30% and 55%. The incidence and dynamics of hematoma expansion in OAT-ICH remain to be established. Current data suggest that the natural course of hematoma expansion in this group of patients is more prolonged as compared to spontaneous ICH. This may provide a longer time window for treatment of OAT-ICH. However, in OAT-ICH the underlying coagulopathy prolongs the time course of bleeding or rebleeding, and repeated dosing or a higher dose might be essential. The risk of thromboembolism that is associated with current hemostatic treatment strategies which aim to normalize coagulation is unknown.