The Pharm So Hard Emergency Medicine & Hospital Pharmacy Podcast Episode 124. Minor Hemorrhages, Major Questions: To Reverse or Not to Reverse in Minor TICH
May 13, 2025
The podcast dives into the intriguing debate over anticoagulation reversal for minor traumatic intracranial hemorrhages. It highlights a recent study that challenges existing guidelines, urging personalized approaches over one-size-fits-all solutions. Listeners will discover the complexities of clinical judgment in these cases and the potential impact on future treatment strategies. This nuanced discussion could change how emergency departments handle such delicate scenarios.
AI Snips
Chapters
Transcript
Episode notes
Reversal May Not Affect Mortality
- A study of 650 patients with minor traumatic intracranial hemorrhage showed no difference in mortality or complications with anticoagulation reversal.
- This suggests reversal may not be necessary for neurologically intact patients in minor TICH cases.
Use Judgment in Reversal Decisions
- Consider that some patients with minor intracranial hemorrhage may avoid reversal to reduce risks and costs.
- Use clinical judgment and individual patient factors when deciding on reversal in minor TICH.
Medico-legal Factors Influence Reversal
- Neurosurgeons often prefer reversing anticoagulation regardless of patient condition, reflecting medico-legal concerns.
- New evidence might encourage more nuanced discussions among teams about reversal timing, especially beyond 12 hours after DOAC use.