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Treatment of Coagulopathy in Intracranial Hemorrhage

  • Critical Care Neurology
  • Published:
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Opinion statement

Intracranial hemorrhage (ICH) complicated by coagulopathy is a medical emergency, which can delay neurosurgical intervention, lead to larger hematoma size, and increase mortality until the coagulopathy is corrected. Prompt recognition of coagulopathy during ICH is essential for correct, rapid treatment to reduce ongoing bleeding and improve survival. The proper treatment of a coagulopathic ICH patient is centered on rapid identification of the coagulopathic defect and correction of the underlying coagulopathy to stop acute bleeding. Patients with coagulopathic ICH require admission to a neuro-intensive unit care with management of airway, oxygenation, and systemic arterial and cerebral perfusion pressure; optimization of serum glucose; aggressive treatment of fever; and rehabilitation. Once the coagulopathic defect is reversed, some patients benefit from emergent neurosurgical intervention to prevent secondary brain injury from raised intracranial pressure, hydrocephalus, or mass effect. The management of ICH patients prescribed common antithrombotics such as aspirin, clopidogrel, warfarin, or heparin, as well as thrombolytic agents such as tissue plasminogen activator, is the focus of this review.

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Acknowledgment

The authors thank Tejal Patel, MD, Mayo Clinic Hematology Consultant, for her careful review of Tables 2 and 3 and clarification of hematologic tests.

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No potential conflicts of interest relevant to this article were reported.

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  1. Department of Neurology, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA

    Maria I. Aguilar MD & William D. Freeman MD

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Correspondence to Maria I. Aguilar MD.

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Aguilar, M.I., Freeman, W.D. Treatment of Coagulopathy in Intracranial Hemorrhage. Curr Treat Options Neurol 12, 113–128 (2010). https://doi.org/10.1007/s11940-010-0061-1

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