Management of warfarin-related intracerebral hemorrhage

Abstract

Warfarin-related intracerebral hemorrhage (WICH) is a medical and neurosurgical emergency with a 1-month mortality of approximately 50%. Warfarin is commonly is used in patients with atrial fibrillation to prevent ischemic stroke and to prevent progression of deep vein thrombosis to pulmonary embolism. Owing to the ageing population, and increased incidence of atrial fibrillation with age and warfarin use, the incidence of WICH is expected to rise in the future. When WICH occurs, immediate discontinuation of warfarin with rapid warfarin reversal remains the first-line intervention, often with neurosurgical intervention. The optimal agent for rapid warfarin anticoagulation reversal remains to be defined owing to the lack of prospective randomized trials. We review current literature and prospects for future research for this devastating neurologic emergency.

Keywords::

• hemorrhage
• intracerebral
• management
• treatment
• warfarin

Financial & competing interests disclosure

William Freeman acknowledges research support provided in part by the Robert H and Clarice Smith/ML Simpson Foundation Trust Research Fellowship. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Modified from Newell CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide to Health Care Professionals. The Pharmaceutical Press, London, 282 (1996).

*Off-label use of rFVIIa. Physicians should consider the potential benefit versus potential risks based on the available limited data, discuss options with the patient or their assigned medical decision-maker before treatment of this and other anticoagulation reversal therapies (e.g., vitamin K and 1/10,000 risk of anaphylactic reaction, future risk of thromboembolic disease from anticoagulation reversal etc), and weigh the patient’s clinical state versus alternate medical and surgical options (if available) for the patient.