NCS/SCCM — NCS SCCM 2026 focused antithrombotic ICH reversal update
NCS/SCCM, 2026
For acute factor-Xa-inhibitor-associated ICH, conditionally prefer 4F-PCC to andexanet. Avoid platelet transfusion for antiplatelet-associated spontaneous IPH without neurosurgery; consider it for aspirin-associated spontaneous IPH requiring surgery. Use viscoelastic assays to guide traumatic ICH coagulopathy. Evidence does not support a recommendation for or against desmopressin, platelet transfusion in traumatic ICH, or reversal in small IPH. Apply patient factors and local availability.
Clinical Context & Relevant Topics (4)
Disease ReferenceSpontaneous ICH vs Aneurysmal SAH, INTERACT-2/ATACH-2 blood pressure targets, emergency anticoagulant reversal, ENRICH minimally invasive evacuation, ISAT coiling, and Nimodipine for delayed cerebral ischemia.
UFH vs LMWH vs DTIs (Argatroban/Bivalirudin), anti-Xa vs aPTT monitoring, and emergency reversal (Protamine, 4F-PCC, Idarucizumab; historical andexanet evidence with current availability caveats).
The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.
Read whole-blood clot initiation, propagation, firmness and lysis without treating device-specific values as universal transfusion orders.