Management of Intracranial
Hemorrhage in Anticoagulated Patients
05 November 2004
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.
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.
vitamin K 10 mg IV or SQ
6 units FFP
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.
FFP should take about 30 minutes.
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.
measure the INR.
of ICP, etc as for other cases of intracranial hemorrhage.