ICU SAQs · Neurocritical care / vascular
Warfarin-related intracerebral haemorrhage — management
A CICM SAQ on warfarin-related ICH — PCC-based reversal, SBP control, spot sign, ICH Score and surgical indications.
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Prompt
A 70-year-old on warfarin (INR 3.5) presents with sudden left-sided weakness and a decreased consciousness. The CT shows a 40 mL right basal ganglia haemorrhage. Outline the management.
Question
A 70-year-old on warfarin (INR 3.5) presents with sudden left-sided weakness and decreased consciousness. CT shows a 40 mL right basal ganglia haemorrhage. Outline the management.[1][2]
References9ShowHide
- [1]Steiner T, Poli S, Griebe M, et al Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial Lancet Neurol, 2016.PMID 27302126
- [2]Anderson CS, Heeley E, Huang Y, et al Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage N Engl J Med, 2013.PMID 23713578
- [3]Qureshi AI, Palesch YY, Barsan WG, et al Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage N Engl J Med, 2016.PMID 27276234
- [4]Wada R, Aviv RI, Fox AJ, et al CT angiography spot sign predicts hematoma expansion in acute intracerebral hemorrhage Stroke, 2007.PMID 17322083
- [5]Hemphill JC 3rd, Bonovich DC, Besmertis L, et al The ICH score: a simple, reliable grading scale for intracerebral hemorrhage Stroke, 2001.PMID 11283388
- [6]Mendelow AD, Gregson BA, Fernandes HM, et al Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial Lancet, 2005.PMID 15680453
- [7]Mendelow AD, Gregson BA, Rowan EN, et al Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial Lancet, 2013.PMID 23726393
- [8]Ma L, Hu X, Song L, et al The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial Lancet, 2023.PMID 37245517
- [9]Fischer MA, Rjepaj C, Steckbeck R, et al. Cerebellar Hemorrhage StatPearls, 2026.PMID 31082120