Management of Intracranial Hemorrhage in Anticoagulated Patients

05 November 2004

It is vital to act quickly. With a patient who is taking coumadin, and has a CNS bleed; do NOT wait for the coagulation panel to be complete to start treatment.

Even patients who have atrial fibrillation or a prosthetic heart valve should have anticoagulation corrected. The risk of thrombosis occurring in the acute period (12-24 hours) is less than the risk of an expanding intracranial hematoma.

1. Order vitamin K 10 mg IV or SQ

2. Order 6 units FFP

3. Call the blood bank to express the urgency of the situation. The blood bank can then immediately thaw, or make available 2 units FFP to start.

4. Thawing FFP should take about 30 minutes.

5. The FFP is given as fast as the patient's cardiovascular system can tolerate, generally 1 unit every 45 minutes-hour. Thus, by the time the last unit is in, the vitamin K is beginning to have effect.

6. Periodically measure the INR.

7. Management of ICP, etc as for other cases of intracranial hemorrhage.