ICH Subdural Hematoma
Bleeding into the space outside the brain under the dura. Acute SDH – caused by tear of bridging veins, rarely from small cortical arterial bleed Chronic SDH: form a hydroma Acute on chronic SDH: from rebleed Risk factors Older age alcohol abuse previous traumatic brain injury more often in...
Cerebellar hemorrhage
Consider surgical treatment if hemorrhage is over 3 cm in diameter, or volume over 15 cm square deteriorating neurologically or Brainstem compression or hydrocephalus...
NOAC associated bleeding
Time Anticoagulation effect resolved 5 half live since last dose Dabigatran (Pradaxa): 2.5 to 3.5 days Rivaroxaban (Xarelto): 1-2 days Apixaban (Eliquis): 1.5 to 3 days Management Discontinue medication Specific reversal agent Dabigatran: idarucizumab (Praxbind) initial dose 2.5 g iv, repeat in 20 min, total of 5 g Apixaban,...
Warfarin associated bleeding
For serious bleeding Discontinue Warfarin Vit K 10 mg slow iv over 20-60 minutes may repeat q12 ir inr still high Kcentra: PCC (4 factor prothrombin complex concentrate) – 1500 to 2000 units iv over 10 min...
Intracerebral hemorrhage (ICH)
Intracerebral Hemorrhage (ICH) Score Initial care airway cardiovascular support acute stroke care facility, ICU care Reversal of anticoagulation & coagulopathy Stop all anticoagulant and antiplatelet Heparin associated bleed Protamine sulfate: slow IV infusion (< 20 mg/minute and no more than 50 mg over any 10-minute period). Warfarin associated ICH:...
ICH – reverse anticoagulant
Received Vit K antagonist (Warfarin) If INR is above normal Use Vit K 10 mg iv, no faster than 1 mg/min, may repeat q 12 if inr remains high 4-factor PCC (Protrhmobin complex concentrate): Kcentra, better than fresh frozen plasma 1500 to 2000 IU at 100 IU/min If above...