🩸 Anticoagulation

Anticoagulation refers to the use of medications that inhibit blood clot formation, reducing the risk of thromboembolic events (e.g., stroke, pulmonary embolism), but increasing the risk of bleeding, especially in the central nervous system.

• Vitamin K antagonists:
  • Example: Warfarin
  • Requires INR monitoring
• Direct oral anticoagulants (DOACs):
  • Direct thrombin inhibitor: Dabigatran
  • Factor Xa inhibitors: Rivaroxaban, Apixaban, Edoxaban
• Heparins:
  • Unfractionated heparin (UFH) – IV, reversible with protamine
  • Low molecular weight heparin (LMWH) – e.g., enoxaparin

• ↑ Risk of intracranial hemorrhage with trauma or surgery
• Delayed bleeding despite initial normal CT
• Potential need for emergency reversal agents
• Influence on surgical timing and postoperative care

Anticoagulation Management