Template:ICH Treatment

Elevating head of bed

• 30 degree elevation will help decrease ICP

Blood Pressure

• Few studies on optimal management however many guidelines recommending moderate reduction

1. SBP >200 or MAP >150
   1. Consider aggressive reduction w/ continuous IV infusion
2. SBP >180 or MAP >130 and evidence or suspicion of elevated ICP
   1. Consider reducing BP using intermittent or continuous IV meds to keep CPP >60-80
3. SBP >180 or MAP >130 and NO evidence or suspicion of elevated ICP
   1. Consider modest reduction of BP (e.g. MAP of 110 or target BP of 160/90)

Reverse coagulopathy

Heparin

1. Give protamine 1mg/100units of heparin based on time since last dose

Warfarin

1. Stop warfarin
2. Give Vitamin K 5-10mg IV INR will decrease over 24-48 hours (small risk of anaphylaxis with IV Vitamin K)
3. Give 4 Factor prothrombin complex concentrate (PCC)
   • If no PCC, then give 15 ml/kg fresh frozen plasma (no benefit to combining PCC and FFP)

Antiplatelet

• includes aspirin, prasagril, clopidogrel

1. Desmopressin (0.3mcg/kg)
2. Platelets

Fondaparinux or Rivaroxaban

1. rFVIIa 2mg (40 mcg/kg)
2. Or PCC 25-50 U/kg
3. Don't give both 2/2 to prothrombotic effects

Dabigatran

1. rFVIIa 100 mcg/kg
2. Or PCC 25-50 U/kg
3. Consider DDAVP 0.3 mcg/kg
4. Hemodialysis, if feasible