Table 1.
Summary of recommendations.
| PICO | Quality of evidence | Strength of recommendation | |
|---|---|---|---|
| 1 | We recommend using PCC (30 IU/kg) in adults with ICH occurring during use of vitamin K antagonists (with an INR above normal) over no treatment to decrease mortality and normalise INR. | Very low | Strong |
| 2 | We recommend using PCC (30 IU/kg) in patients with ICH occurring during use of vitamin K antagonists (with an INR above normal) over FFP (20 mL/kg) to decrease mortality and normalise INR. | Moderate | Strong |
| 3 | In adult patients with ICH occurring during use of vitamin K antagonists (with an INR above normal) we recommend using vitamin K (10 mg IV) in addition to fast reversal strategies including PCC to prevent re-increase of INR to decrease haematoma expansion and decrease mortality | Very low | Strong |
| 4 | In patients with ICH occurring during use of vitamin K antagonists, we recommend against using rFVIIa to improve outcome, decrease haematoma expansion or increase normalisation of INR. | Very low | Strong |
| 5 | In adult patients with ICH occurring during use of vitamin K antagonists (with an INR above normal) we recommend against use of tranexamic acid. | Very low | Strong |
| 6 | In patients with ICH occurring during use of NOAC (fXa inhibitors), we recommend to consider the use of 4-factor PCC (37.5–50 IU/kg) to reverse the anticoagulant effect. | Very low | Weak |
| 7 | In patients with ICH occurring during use of NOAC, we recommend against using FFP to improve outcome, reduce mortality, decrease haematoma expansion or reverse the effects of NOAC. | Very low | Weak |
| 8 | In adult patients with ICH occurring during use of dabigatran, idarucizumab is recommended to reverse effects of dabigatran. | Low | Strong |
| 9 | In adult patients with ICH occurring during use of rivaroxaban or apixaban, andexanet alfa may be considered to reverse the anticoagulant effect. | Low | Weak |
| 10 | We recommend against the administration of ciraparantag outside of clinical trials. | Very low | Strong |
PICO: Population, Intervention, Comparator and Outcome; PCC: prothrombin complex concentrate; ICH: intracerebral haemorrhage; INR: international normalised ratio; IV: intravenously; NOAC: non-vitamin K antagonist oral anticoagulation; FFP: fresh-frozen plasma; IU: international units.