Hemorrhagic stroke

1. Keep MAP <130 during acute phase
2. If on coumadin with INR >2 consider reversal:
   1. Vitamin K 10mg IV gtt over 10min
      1. Small risk of anaphylaxis
      2. Takes 6-12hr to work
   2. FFP
      1. Usually need up to 6 units to bring INR to 1.2
      2. Be careful about volume overload in elderly
      3. Takes hours to work
   3. Prothrombin complex concentrate (25-50mg/kg IV)
      1. Fast-acting but expensive
3. Desmopressin
   1. Can increase activity of platelets via vWF

Source

Arabinda Pani, MD

2/20/2010