The following is a summary of “Time to oral anticoagulant reversal in intracranial hemorrhage with an emergency medicine pharmacist presence,” published in the June 2024 issue of Emergency Medicine by Hutcheson, et al.

Intracranial hemorrhage (ICH) is a serious condition with high morbidity and mortality rates, often exacerbated by oral anticoagulant (OAC) use. Emergency medicine (EM) pharmacists were critical in rapidly and appropriately managing OAC-associated ICH in the emergency department (ED). For a study, researchers sought to assess the impact of EM pharmacist presence on the timeliness of OAC reversal in patients presenting with ICH.

The retrospective cohort study was conducted at a level-one trauma center from November 2016 to September 2022. Eligible participants were adults aged 18 years or older diagnosed with OAC-associated ICH upon ED presentation and who received at least one dose of an emergent reversal agent. Patients diagnosed elsewhere, receiving reversal agents for reasons other than ICH, or with do-not-resuscitate orders were excluded. The primary endpoint was the time to administration of the reversal agent, reported as median [interquartile range]. Secondary outcomes included hematoma expansion, hospital length of stay (LOS), intensive care unit (ICU) LOS, and in-hospital mortality.

Among 157 initially evaluated patients, 83 met the inclusion criteria. The majority presented with warfarin-associated ICH (55%), primarily due to atrial fibrillation (66%). Intracerebral hemorrhage was the most common type (35%). The median time to administration of the reversal agent was significantly shorter in the presence of an EM pharmacist (50 min [31–65] vs. 85 min [51–121], P < 0.01). No significant differences were observed in secondary outcomes.

The presence of an EM pharmacist at the bedside during the ED presentation of ICH with OAC use was associated with a notable reduction in time to OAC reversal by 36 minutes. However, in the study cohort, it did not translate into improved clinical outcomes regarding hematoma expansion, hospital or ICU LOS, or in-hospital mortality. Larger-scale trials were necessary to evaluate whether EM pharmacist involvement improves functional and clinical outcomes in patients with OAC-associated ICH, especially concerning newer reversal agents beyond 4-factor prothrombin complex concentrate (4F-PCC).

Reference: sciencedirect.com/science/article/abs/pii/S0735675724001220