Novel Oral Anticoagulants and Intracranial Hemorrhage

With the increasing use of novel oral anticoagulants (NOACs) or direct oral anticoagulants, vascular neurologists and neurocritical care providers are more commonly encountering situations in which decisions need to be made about either starting or reversing these medications. The most common clinical indication for the NOACs is atrial fibrillation, and the most dreaded complication of NOACs is intracranial hemorrhage (ICH). This brief review will summarize the data on the safety and efficacy of the NOACs, with an emphasis on ICH, as well as the strategies to reverse the anticoagulation effects of the NOACs in those suffering bleeding complications

α-MSH: A potential neuroprotective and immunomodulatory agent for the treatment of stroke

Alpha-melanocyte-stimulating hormone (MSH) is a neuropeptide with profound immunomodulatory properties; we evaluated the effects of α-MSH on stroke outcome and its ability to modulate the postischemic immune response. In Lewis rats subjected to 3 hours of middle cerebral artery occlusion (MCAO), plasma concentrations of α-MSH rapidly decreased and returned to baseline over the course of days. Exogenous administration of α-MSH (100 or 500 μg/kg) improved 24 hour outcome in animals subjected to 2 hours MCAO; α-MSH 500 μg/kg also decreased infarct volume at this time point. Both doses of α-MSH were ineffective in improving outcome or decreasing infarct volume in animals subjected to 3 hours MCAO. The splenocyte response to phytohemagglutin in animals treated with α-MSH was attenuated at 24 hours after MCAO. At 1 month after MCAO, treatment with α-MSH 500 μg/kg at the time of stoke was associated with a decrease in TH1 response to myelin basic protein (MBP) in animals subjected to 2 hours MCAO, although treatment was not associated with improved outcome at this time point. Given the early benefits of α-MSH treatment and its effect on immunologic outcome, further studies to evaluate the utility of α-MSH for the treatment of cerebral ischemia are warranted