Template:ICH Treatment: Difference between revisions
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*30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref> | *30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref> | ||
===Blood Pressure=== | ===Blood Pressure=== | ||
*Few studies on optimal management however many [[Intracranial_Hemorrhage_(Main) | *Few studies on optimal management however many [[Intracranial_Hemorrhage_(Main)*Blood_Pressure_Guidelines|guidelines recommending moderate reduction ]] | ||
*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=== | ===Reverse coagulopathy=== | ||
====Heparin==== | ====Heparin==== | ||
*Give protamine 1mg/100units of heparin based on time since last dose | |||
====[[Warfarin (Coumadin) Reversal|Warfarin]]==== | ====[[Warfarin (Coumadin) Reversal|Warfarin]]==== | ||
{{Warfarin Reversal}} | {{Warfarin Reversal}} | ||
| Line 19: | Line 19: | ||
====Antiplatelet==== | ====Antiplatelet==== | ||
*includes aspirin, prasagril, clopidogrel | *includes aspirin, prasagril, clopidogrel | ||
*Desmopressin (0.3mcg/kg) | |||
*Platelets | |||
====Fondaparinux or Rivaroxaban==== | ====Fondaparinux or Rivaroxaban==== | ||
*rFVIIa 2mg (40 mcg/kg) | |||
*''Or'' PCC 25-50 U/kg | |||
*Don't give both 2/2 to prothrombotic effects | |||
====Dabigatran==== | ====Dabigatran==== | ||
*rFVIIa 100 mcg/kg | |||
*''Or'' PCC 25-50 U/kg | |||
*Consider DDAVP 0.3 mcg/kg | |||
*Hemodialysis, if feasible | |||
Revision as of 05:41, 6 June 2015
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
- 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)
- Platelets
Fondaparinux or Rivaroxaban
- rFVIIa 2mg (40 mcg/kg)
- Or PCC 25-50 U/kg
- Don't give both 2/2 to prothrombotic effects
Dabigatran
- rFVIIa 100 mcg/kg
- Or PCC 25-50 U/kg
- Consider DDAVP 0.3 mcg/kg
- Hemodialysis, if feasible