Abstract DP165: Anticoagulant Reversal in Intracerebral Hemorrhage: Insights from a National Survey

Background: Intracerebral hemorrhage (ICH) accounts for 10–15% of strokes and is associated with high mortality and disability. Rapid reversal of direct oral anticoagulants (DOACs) is essential to limit hematoma expansion. The American Heart Association (AHA), through the Get WithThe Guidelines® (GWTG)-Stroke program, conducted a national survey to assess current practices in DOAC reversal for acute ICH. Methods: 675 GWTG-Stroke hospitals who collect relevant ICH metrics were sent a structured survey. Topics addressed patient referral patterns, timing and decision-making in DOAC reversal, diagnostic tools, and implementation challenges. Hospitals were encouraged to consult process stakeholders to ensure complete responses. Results: Summary statistical analyses were performed using Microsoft Excel. Open ended questions were aggregated thematically; there was a 20% response rate. Significant variability and gaps exist in DOAC reversal practices for ICH, with over 20% of responding hospitals lack formal protocols and frequent delays due to workflow and lab confirmation issues. Decision-making and treatment delays are influenced by protocol inconsistencies, unclear authority, timing of the last DOAC dose, delays in diagnosis and limited agent availability. Discussion: Respondents highlighted opportunities for quality improvement. Themes included the need for ongoing staff training with mock alerts, establishment of clear DOAC/ICH policies, and implementation of standardized guideline-aligned protocols integrated within the EHR. Emphasis on well-defined workflows to support rapid ICH identification, timely lab turnaround, and active pharmacy involvement was noted. Continuous process review is essential to sustain this time-sensitive intervention.