Hemorrhagic stroke

AHA Guidlines

1. Keep MAP <130 during acute phase
2. When patient is anticoagulated on warfarin with INR > 2.0 should consider reversal with following:
   1. Vitamin K 10mg IV (small risk of anaphylaxis, takes up to 6 hours to work)
3. FFP (generally need up to 6 units to bring INR to 1.2; careful about volume overload in the elderly)
4. Prothrombin Complex Concentrate (25-50mg/kg IV)
   1. very expensive with limited data but trends are moving towards using this in life threatening bleeding. can decrease hematoma expansion.
5. Desmopressin: can increase activity of platelets via vWF

Source

Arabinda Pani, MD

2/20/2010