UMEM Educational Pearls

Title: Warfarin and ICH

Posted: 3/16/2010 by Mike Winters, MBA, MD (Updated: 11/22/2024)
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Warfarin and ICH

Warfarin causes approximately 10-15% of all intracerebral hemorrhages (ICH)
Many warfarin-related ICHs occur with INRs in the therapeutic range
Patients with warfarin-related ICH have higher mortality and typically suffer worse neurologic outcome
The primary pitfall in treating patients with warfarin-related ICH is the failure to rapidly normalize the INR
Do not delay treatment while awaiting the results of coagulation labs
Patients should receive IV vitamin K via slow infusion and FFP
Prothrombin Complex Concentrate (PCC) is gaining popularity but much of the supporting literature uses agents not available in the US
Similarly, there is no significant evidence that recombinant factor VIIa improves outcomes in patients with warfarin-related ICH

Rincon F, Mayer SA. Clinical review: Critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008; 18:237.

Goldstein JN, Rosand J, Schwamm LH. Warfarin reversal in anticoagulant-associated intracerebral hemorrhage. Neurocrit Care2008; 9:277-83.