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This focused update evaluated the available evidence after publication of the 2016 guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Neurocritical Care Society, in conjunction with the Society of Critical Care Medicine, generated five questions to guide a systematic review and meta-analysis. Three of these questions update prior recommendations, while two are newly introduced. Each question followed a Population, Intervention, Comparator, Outcome (PICO) framework and focused on the management of acute ICH including spontaneous intraparenchymal hemorrhage (IPH) and traumatic ICH. The topics addressed were: (1) andexanet alfa versus 4-factor prothrombin complex concentrate (4F-PCC) for treatment of oral factor Xa inhibitor effects; (2) platelet transfusion versus no transfusion for treatment in the setting of antiplatelet agent use; (3) desmopressin versus no desmopressin for treatment in the setting of antiplatelet agent use; (4) treatment of anticoagulant effects versus no treatment in the setting of small IPH; and (5) use of viscoelastic hemostatic assays (VHAs) to treat coagulopathy in traumatic ICH. Recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The panel generated eight recommendations. For patients with acute ICH, the panel issued the following conditional recommendations: use 4F-PCC rather than andexanet alfa for the treatment of the anticoagulant effects of factor Xa inhibitors, avoid platelet transfusion in non-neurosurgical patients with spontaneous IPH on antiplatelet agents, administer platelet transfusion in patients with spontaneous IPH on aspirin who are undergoing surgery, and use VHAs to guide treatment of coagulopathy in traumatic ICH. The panel was unable to issue recommendations regarding platelet transfusion for treatment of antiplatelet effects in traumatic ICH, use of desmopressin for treatment of antiplatelet effects, or treatment of anticoagulant effects in small IPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The guideline writing panel provided new conditional recommendations for the treatment of antithrombotic-associated acute ICH. These recommendations are intended for consideration along with the patient\u2019s clinical status and patient-specific factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-026-02601-4","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T18:31:07Z","timestamp":1790274667000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment of Antithrombotic-Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update from the Neurocritical Care Society and the Society of Critical Care Medicine"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8164-8145","authenticated-orcid":false,"given":"Meghan Caylor","family":"Vallejo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori S.","family":"Kennedy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Dengler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Barthol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie P.","family":"Belley-Cote","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph D.","family":"Burns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veda K.","family":"Chau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Cordonnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Cuker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimia","family":"Honarmand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherif Hanafy","family":"Mahmoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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J Trauma Acute Care Surg. 2020;89(6):999\u20131017. https:\/\/doi.org\/10.1097\/TA.0000000000002944.","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Neurocritical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-026-02601-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12028-026-02601-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-026-02601-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:31:42Z","timestamp":1790314302000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12028-026-02601-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":87,"alternative-id":["2601"],"URL":"https:\/\/doi.org\/10.1007\/s12028-026-02601-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-8928593\/v1","asserted-by":"object"}]},"ISSN":["1541-6933","1556-0961"],"issn-type":[{"value":"1541-6933","type":"print"},{"value":"1556-0961","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"assertion":[{"value":"25 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Charlotte Cordonnier discloses the following: (i) Financial: Honoraria from Bayer (modest, $500\u201350,000) for her role on a Steering Committee for a phase 3 trial for Factor XI inhibitors (ii) Intellectual: TIPITCH project Coordinator\u2014Funded by the France 2030\u2014aims at transforming the prognosis of intracerebral hemorrhage with a special focus on bleeding associated with oral anticoagulants. Member of the writing committees for ESO ICH guidelines 2025 and AHA\/ASA ICH guidelines (2022). Adam Cuker discloses the following: (i) Financial: Honorarium from Pfizer (modest, $500\u201350,000) for his role as a consultant. Authorship royalties (modest, $500\u201350,000) from UpToDate for his role as an author. Emilie Belley-Cote discloses the following: (i) Financial: Research grant from Abbott (significant:\u2009>\u2009$50,000) for her role as a researcher to fund a trial assessing different INR targets for mechanical valves. Joseph Burns discloses the following: (i) Intellectual: serves as a member of the editorial board for\n                      Neurology\n                      and\n                      Neurocritical Care\n                      .","order":1,"name":"Ethics","label":"Conflicts of Interest","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"No IRB approval was necessary for writing this guideline.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Artificial intelligence was not used in the development or writing of this manuscript.","order":3,"name":"Ethics","label":"Artificial Intelligence","group":{"name":"EthicsHeading","label":"Ethics"}}]}}