Hemorrhagic stroke

AHA Guidlines:

Keep MAP <130 during acute phase

When patient is anticoagulated on warfarin with INR > 2.0 should consider reversal with following:

Vitamin K 10mg IV (small risk of anaphylaxis, takes up to 6 hours to work)

FFP (generally need up to 6 units to bring INR to 1.2; careful about volume overload in the elderly)

Prothrombin Complex Concentrate (25-50mg/kg IV)

 very expensive with limited data but trends are moving towards using this in life threatening bleeding.  can decrease hematoma expansion.

Desmopressin: can increase activity of platelets via vWF

Arabinda Pani, MD

2/20/2010