UMEM Educational Pearls

Category: Critical Care

Title: Hemostatic Therapy for ICH

Posted: 8/24/2010 by Mike Winters, MD (Updated: 5/29/2023)
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Hemostatic Therapy for ICH - Updated Guidelines

  • The AHA/ASA just published updated guidelines for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage (ICH).
  • Regarding hemostatic therapy, new/revised recommendations from the 2007 AHA/ASA guidelines include:
    • Patients with severe thrombocytopenia or factor deficiency should receive platelets or factor replacement
    • Patients with ICH due to oral anticoagulants (warfarin) should receive intravenous vitamin-K and vitamin-K dependent factor replacement
      • Prothrombin complex concentrates (PCCs) are being increasingly used and are considered a reasonable alternative to FFP.  To date, studies have not shown improved outcome with PCCs.
      • Recombinant factor VIIa (rFVIIa) is not recommended as a sole agent for warfarin-related ICH
    • rFVIIa is not recommended in unselected patients
    • Usefulness of platelet transfusions for patients using antiplatelet medications is unclear and currently investigational.


Morgenstern LB, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke 2010;41:00-00.