Template:ICH Treatment: Difference between revisions

Revision as of 12:26, 8 December 2014

Elevating head of bed

30 degree elevation will help decrease ICP^[1]

Blood Pressure

Few studies on optimal managment however many guideliness recommending moderate reduction ^[2]

SBP >200 or MAP >150
1. Consider aggressive reduction w/ continuous IV infusion
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
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

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

[1] ttp://stroke.ahajournals.org/content/38/6/2001.full

[2] Intracranial_Hemorrhage_(Main)#Blood_Pressure_Guidelines

[1]

[2]

@@ Line 1: / Line 1: @@
-#Elevating head of bed to 30 degrees (if pt not hypotensive)
+===Elevating head of bed===
-#Blood pressure
+*30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref>
-##SBP >200 or MAP >150
+===Blood Pressure===
-###Consider aggressive reduction w/ continuous IV infusion
+*Few studies on optimal managment however many guideliness recommending moderate reduction <ref>[[Intracranial_Hemorrhage_(Main)#Blood_Pressure_Guidelines]]</ref>
-##SBP >180 or MAP >130 and evidence or suspicion of elevated ICP
+#SBP >200 or MAP >150
-###Consider reducing BP using intermittent or continuous IV meds to keep CPP >60-80
+##Consider aggressive reduction w/ continuous IV infusion
-##SBP >180 or MAP >130 and NO evidence or suspicion of elevated ICP
+#SBP >180 or MAP >130 and evidence or suspicion of elevated ICP
-###Consider modest reduction of BP (e.g. MAP of 110 or target BP of 160/90)
+##Consider reducing BP using intermittent or continuous IV meds to keep CPP >60-80
-#Reverse coagulopathy
+#SBP >180 or MAP >130 and NO evidence or suspicion of elevated ICP
-##Heparin
+##Consider modest reduction of BP (e.g. MAP of 110 or target BP of 160/90)
-###Give protamine 1mg/100units of heparin based on time since last dose
-##Warfarin
+===Reverse coagulopathy===
-###Reverse regardless of INR
+====Heparin====
-###Prothrombin complex concentrate 20-50mg/kg IV x1 OR
-###FFP + vit K 10mg IV over 10min
+#Give protamine 1mg/100units of heparin based on time since last dose
-##ASA/clopidogrel
+====[[Warfarin (Coumadin) Reversal|Warfarin]]====
-###Desmopressin (0.3mcg/kg)
+{{Warfarin Reversal}}
-###Platelets
-##Fondaparinux or Rivaroxaban
+====Antiplatelet====
-###rFVIIa 2mg (40 mcg/kg)
+*includes aspirin, prasagril, clopidogrel
-###''Or'' PCC 25-50 U/kg
+#Desmopressin (0.3mcg/kg)
-###Don't give both 2/2 to prothrombotic effects
+#Platelets
-##Dabigatran
+====Fondaparinux or Rivaroxaban====
-###rFVIIa 100 mcg/kg
+#rFVIIa 2mg (40 mcg/kg)
-###''Or'' PCC 25-50 U/kg
+#''Or'' PCC 25-50 U/kg
-###Consider DDAVP 0.3 mcg/kg
+#Don't give both 2/2 to prothrombotic effects
-###Hemodialysis, if feasible
+====Dabigatran====
+#rFVIIa 100 mcg/kg
+#''Or'' PCC 25-50 U/kg
+#Consider DDAVP 0.3 mcg/kg
+#Hemodialysis, if feasible