Abstract Number ‐ 230: Mobile Stroke Unit Experience With Anticoagulant Related Intracranial Hemorrhage

Abstract

Introduction The advent of mobile stroke units (MSU) provide a golden opportunity to rapidly reverse anticoagulant related intracranial hemorrhage (AC‐ICH) in the pre‐hospital setting. The timely reversal of anticoagulants is crucial in halting hematoma expansion and achieving good clinical outcomes. It is known that AC‐ICH is associated with higher mortality rate and higher hematoma expansion than spontaneous ICH. Multiple studies showed that rapid reversal of AC‐ICH is associated with better outcomes and more stability of the hematoma size. Studies showed there is delay in initiation of therapy and revere the anticoagulants in ICH cases, [1,2}. Here, we report 3 cases of AC‐ICH diagnosed on the MSU with pre‐hospital use of reversal agents. To our knowledge, this is the first case series of Non vitamin K antagonist oral anticoagulants (NOACS) on the MSU. Methods We reviewed the MSU data from May 2016 to December 2020 and those with AC‐ICH were selected. Baseline demographics and clinical presentation were obtained including clinical outcome. Results A total of 3 patients were identified. Patient 1 is a96 year‐oldfemale with history of Atrial fibrillation (AF) that presented with AC‐ICH related to Apixaban and was treated with Prothrombin complex concentrate (PCC). The time of MSU examination to treatment (MSUe‐T) was 41 minutes.The patient was neurologically intact and discharged home after 4 days, no further images were indicated as the patient was stable and back to baseline. Patient 2 is a68 year‐oldmale with history of deep vein thrombosis that presented with AC‐ICH related to Warfarin and was treated with PCC. TheMSUe‐T was 64 minutes. Repeated CT head in the ED was stable. Neurological exam improved and the patient discharged to a skilled nursing facility. Patient 3 is a79 year oldmale with history of AF that presented with AC‐ICH related to Rivaroxaban and was treated with PCC. TheMSUe‐T was 50 minutes. Repeated CT head after 3 days was stable. According to FASTEST trial, the average time from onset to treatment of AC‐ICH was 90–120 min.In this trial, the growth of the ICH during the first hours was associated with increase mortality rate,{3} Conclusions Our data demonstrated that management of AC‐ICH on the MSU is feasible and provides an ample opportunity to reverse AC in the hyper‐early stage of ICH. MSU might have an important role in reducing the mortality for AC‐ICH patients. Larger comparative studies between Emergency department and MSU are needed.