Template:ICH Treatment: Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
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*includes aspirin, prasagril, clopidogrel | *includes aspirin, prasagril, clopidogrel | ||
*Desmopressin (0.3mcg/kg) | *Desmopressin (0.3mcg/kg) | ||
* | *Transfusion of platelets has been shown to increase mortality<ref>Baharoglu MI, Cordonnier C, Salman RA, et al. Platelet Transfusion Versus Standard Care After Acute Stroke due to Spontaneous Cerebral Haemorrhage Associated with Antiplatelt Therapy (PATCH): A Randomised, Open-Label, Phase 3 Trial. Lancet. 2016; 1 – 9. [Epub ahead of print]</ref> | ||
====Fondaparinux or Rivaroxaban==== | ====Fondaparinux or Rivaroxaban==== | ||
*rFVIIa 2mg (40 mcg/kg) | *rFVIIa 2mg (40 mcg/kg) | ||
Revision as of 11:19, 22 June 2016
Elevating head of bed
- 30 degree elevation will help decrease ICP[1]
Blood Pressure
- Few studies on optimal management however many guidelines recommending moderate reduction , often a goal systolic of 140-160's.
- SBP >200 or MAP >150
- Consider aggressive reduction w/ continuous IV infusion
- SBP >180 or MAP >130 and evidence or suspicion of elevated ICP
- Consider reducing BP using intermittent or continuous IV meds to keep CPP >60-80
- SBP >180 or MAP >130 and NO evidence or suspicion of elevated ICP
- Consider modest reduction of BP (e.g. MAP of 110 or target BP of 160/90)
Reverse coagulopathy
Heparin
- Give protamine 1mg/100units of heparin based on time since last dose
Warfarin
- Stop warfarin
- Give Vitamin K 5-10mg IV INR will decrease over 24-48 hours (small risk of anaphylaxis with IV Vitamin K)
- 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
- Desmopressin (0.3mcg/kg)
- Transfusion of platelets has been shown to increase mortality[2]
Fondaparinux or Rivaroxaban
- rFVIIa 2mg (40 mcg/kg)
- Or PCC 25-50 U/kg
- Don't give both 2/2 to prothrombotic effects
Dabigatran
- Idarucizumab (Praxbind): 5 grams IV (approved as of October 2015)
- rFVIIa 100 mcg/kg
- Or PCC 25-50 U/kg
- Consider DDAVP 0.3 mcg/kg
- Hemodialysis, if feasible
- ↑ http://stroke.ahajournals.org/content/38/6/2001.full
- ↑ Baharoglu MI, Cordonnier C, Salman RA, et al. Platelet Transfusion Versus Standard Care After Acute Stroke due to Spontaneous Cerebral Haemorrhage Associated with Antiplatelt Therapy (PATCH): A Randomised, Open-Label, Phase 3 Trial. Lancet. 2016; 1 – 9. [Epub ahead of print]