Anticoagulant-induced intracerebral haemorrhage (ICH): management

Management of Warfarin-induced ICH

• Stop anticoagulation for 1-2 weeks
• Fresh frozen plasma (FFP) at 10-50 U/kg
• Alternatively prothrombin complex concentrate (PCC) at 10-50 U/kg
• Administer Vitamin K 5-10mg IV
• Recombinant factor VIIa 40-80 microg/kg: this is not effective alone for reversal of bleeding
• Platelet transfusion: this is investigational

Management of Dabigatran-induced ICH

Management of Rivaroxaban and Apixaban-induced ICH

Management of Edoxaban-induced ICH

Management of heparin-induced ICH

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Acronym

References

1. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-2236.
2. Hemphill JC 3rd, Greenberg SM, Anderson CS, et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46:2032-2060.
3. Boulouis G, Morotti A, Pasi M, Goldstein JN, Gurol ME, Charidimou A. Outcome of intracerebral haemorrhage related to non-vitamin K antagonists oral anticoagulants versus vitamin K antagonists: a comprehensive systematic review and meta-analysis. JNNP 2017; pii: jnnp-2017-316631 (Epub ahead of print).
4. Christensen H, Cordonnier C, Kõrv J, et al. European Stroke Organisation guideline on reversal of oral anticoagulants in acute intracerebral haemorrhage. Eur Stroke J 2019; 4:294-306.

Related checklists

• Anticoagulant-induced intracerebral haemorrhage (ICH): risk factors and outcomes
• Anticoagulant-induced intracerebral haemorrhage (ICH): resuming anticoagulation