title: Intracerebral hemorrhage in patients receiving oral anticoagulation therapy.
abstract: Intracerebral hemorrhage (ICH) in patients with oral anticoagulation therapy is an increasingly prevalent problem in large part due to the aging population and the increased use of anticoagulants for patients at high risk of thrombosis. Warfarin has been virtually the only outpatient anticoagulant choice until fairly recently. The development of subcutaneously injected heparinoids, and more recently, of direct thrombin inhibitors, has made the treatment and prognostication of ICH in anticoagulated patients more difficult. In this review, we will review the current state of diagnosis, prognostication, and treatment for patients with this often-devastating type of bleeding. We will focus on warfarin therapy, because the preponderance of evidence comes from studies of warfarin treatment. Where there is evidence, we will contrast warfarin with some of the newer treatment modalities. We review the evidence of the 4 major reversal agents for warfarin, vitamin K, prothrombin complex concentrates, activated factor VII, and fresh frozen plasma as well as rational treatment choices. We offer possible treatments for the newer anticoagulants based on the limited evidence available. Finally, we review recommendations from the major societies and studies that support early and aggressive therapies in intensive care units with dedicated neurological specialists.
authors.affiliation: Neurointensive Care Unit, Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ivan Rocha Ferreira
authors.initials: IR
authors.lastname: da Silva
authors.affiliation: Neurointensive Care Unit, Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA Neuroinflammation Research Center, Cleveland Clinic, Cleveland, OH, USA provenj@ccf.org.
authors.forename: J Javier
authors.initials: JJ
authors.lastname: Provencio
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000517:prevention & control; D003422:Critical Care; D015942:Factor VIIa / Q000627:therapeutic use*; D006801:Humans; D010949:Plasma; D013927:Thrombosis / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D014812:Vitamin K / Q000627:therapeutic use*; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin; D015942:Factor VIIa
keywords: factor VIIa; intracerebral hemorrhage; oral anticoagulation; prothrombin complex concentrates; warfarin