In an associated editorial the author describes how clinicians have been forced to use a variety of interventions [including Fresh frozen plasma; 3-factor, 4-factor, and activated prothrombin complex concentrates (PCCs); recombinant factor VIIa; and cryoprecipitate] to treat this condition in patients talking NOACs with no real evidence available to guide practice. In this study it is reported that 57% of patients received a PCC. These patients had more severe clinical deficits, more often had a deep haemorrhage, and had more recent NOAC ingestion than those who were not treated with a PCC. There was no difference in the frequency of hematoma expansion or in clinical outcome between the 2 groups, and when viewed as a group, the PCC-treated patients ended up with significantly more blood on follow-up computed tomography than at baseline.
However there is some hope that management will improve in the future as antidotes for these products are in the late stage of clinical development and should become available within the next year or so.