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{{Epidural hematoma}}
{{Epidural hematoma}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}{{MMJ}}


==Overview==
==Overview==
The mainstay of treatment for epidural hematoma is surgery.
The mainstay of treatment for epidural hematoma is urgent surgery.


==Medical Therapy==
==Medical Therapy==
*
*The mainstay of treatment for epidural hematoma is urgent surgery.<ref name="pmid26567227">{{cite journal| author=Maugeri R, Anderson DG, Graziano F, Meccio F, Visocchi M, Iacopino DG| title=Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature. | journal=Am J Case Rep | year= 2015 | volume= 16 | issue=  | pages= 811-7 | pmid=26567227 | doi= | pmc=4652627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26567227  }} </ref>
*In patients whith uncontrolled or life-threatening bleeding(like progressive epidural hematoma) who are taking apixaban or rivaroxaban, reversal of anticoagulation may be considered by Andexanet alfa.<ref name="pmid23455714">{{cite journal| author=Lu G, DeGuzman FR, Hollenbach SJ, Karbarz MJ, Abe K, Lee G et al.| title=A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. | journal=Nat Med | year= 2013 | volume= 19 | issue= 4 | pages= 446-51 | pmid=23455714 | doi=10.1038/nm.3102 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23455714  }} </ref>
*In patients with uncontrolled or life-threatening [[bleeding]] (such as progressive epidural hematoma); who are taking [[apixaban]] or [[rivaroxaban]], reversal of [[Anticoagulant|anti-coagulation]] may be done by Andexanet alfa.<ref name="pmid23455714">{{cite journal| author=Lu G, DeGuzman FR, Hollenbach SJ, Karbarz MJ, Abe K, Lee G et al.| title=A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. | journal=Nat Med | year= 2013 | volume= 19 | issue= 4 | pages= 446-51 | pmid=23455714 | doi=10.1038/nm.3102 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23455714  }} </ref><ref name="pmid27573206">{{cite journal| author=Connolly SJ, Milling TJ, Eikelboom JW, Gibson CM, Curnutte JT, Gold A et al.| title=Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 12 | pages= 1131-41 | pmid=27573206 | doi=10.1056/NEJMoa1607887 | pmc=5568772 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27573206  }} </ref><ref name="pmid28282497">{{cite journal| author=Nafee T, Aslam A, Chi G, Pahlavani S, Nimri D, Kuchkuntla AR et al.| title=Andexanet alfa for the reversal of anticoagulant activity in patients treated with direct and indirect factor Xa inhibitors. | journal=Expert Rev Cardiovasc Ther | year= 2017 | volume= 15 | issue= 4 | pages= 237-245 | pmid=28282497 | doi=10.1080/14779072.2017.1305889 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28282497  }} </ref><ref name="pmid28002711">{{cite journal| author=Connolly SJ, Gibson CM, Crowther M| title=Andexanet Alfa for Factor Xa Inhibitor Reversal. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 25 | pages= 2499-500 | pmid=28002711 | doi=10.1056/NEJMc1613270 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28002711 }} </ref><ref name="pmid29590221">{{cite journal| author=Lu G, Pine P, Leeds JM, DeGuzman F, Pratikhya P, Lin J et al.| title=Andexanet alfa effectively reverses edoxaban anticoagulation effects and associated bleeding in a rabbit acute hemorrhage model. | journal=PLoS One | year= 2018 | volume= 13 | issue= 3 | pages= e0195122 | pmid=29590221 | doi=10.1371/journal.pone.0195122 | pmc=5874076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29590221 }} </ref>
*
**Andexanet alfa Dosing Regimens: '''Low dose''': 400 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute IV infusion for up to 120 minutes '''High dose''': 800 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute IV infusion for up to 120 minutes
*
*
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
===Disease Name===
 
 
 
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days  
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''  
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days  
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 
 
 
 
 
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== Medical therapy ==
 
* [[Anticonvulsant]] medications (such as [[phenytoin]]) may be used to control or prevent [[Seizure (patient information)|seizures]].
 
* Some medications called "hyperosmotic agents" (like [[mannitol]], [[glycerol]], and [[hypertonic saline]]) may be used to reduce brain swelling.
 


==References==
==References==

Latest revision as of 16:17, 6 June 2018


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

The mainstay of treatment for epidural hematoma is urgent surgery.

Medical Therapy

  • The mainstay of treatment for epidural hematoma is urgent surgery.[1]
  • In patients with uncontrolled or life-threatening bleeding (such as progressive epidural hematoma); who are taking apixaban or rivaroxaban, reversal of anti-coagulation may be done by Andexanet alfa.[2][3][4][5][6]
    • Andexanet alfa Dosing Regimens: Low dose: 400 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute IV infusion for up to 120 minutes High dose: 800 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute IV infusion for up to 120 minutes

References

  1. ↑ Maugeri R, Anderson DG, Graziano F, Meccio F, Visocchi M, Iacopino DG (2015). "Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature". Am J Case Rep. 16: 811–7. PMC 4652627. PMID 26567227.
  2. ↑ Lu G, DeGuzman FR, Hollenbach SJ, Karbarz MJ, Abe K, Lee G; et al. (2013). "A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa". Nat Med. 19 (4): 446–51. doi:10.1038/nm.3102. PMID 23455714.
  3. ↑ Connolly SJ, Milling TJ, Eikelboom JW, Gibson CM, Curnutte JT, Gold A; et al. (2016). "Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors". N Engl J Med. 375 (12): 1131–41. doi:10.1056/NEJMoa1607887. PMC 5568772. PMID 27573206.
  4. ↑ Nafee T, Aslam A, Chi G, Pahlavani S, Nimri D, Kuchkuntla AR; et al. (2017). "Andexanet alfa for the reversal of anticoagulant activity in patients treated with direct and indirect factor Xa inhibitors". Expert Rev Cardiovasc Ther. 15 (4): 237–245. doi:10.1080/14779072.2017.1305889. PMID 28282497.
  5. ↑ Connolly SJ, Gibson CM, Crowther M (2016). "Andexanet Alfa for Factor Xa Inhibitor Reversal". N Engl J Med. 375 (25): 2499–500. doi:10.1056/NEJMc1613270. PMID 28002711.
  6. ↑ Lu G, Pine P, Leeds JM, DeGuzman F, Pratikhya P, Lin J; et al. (2018). "Andexanet alfa effectively reverses edoxaban anticoagulation effects and associated bleeding in a rabbit acute hemorrhage model". PLoS One. 13 (3): e0195122. doi:10.1371/journal.pone.0195122. PMC 5874076. PMID 29590221.

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