Template:ICH Treatment

1. Elevating head of bed to 30 degrees (if pt not hypotensive)
2. Blood pressure
   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)
3. Reverse coagulopathy
   1. Heparin
      1. Give protamine 1mg/100units of heparin based on time since last dose
   2. Warfarin
      1. Reverse regardless of INR
      2. Prothrombin complex concentrate 20-50mg/kg IV x1 OR
      3. FFP + vit K 10mg IV over 10min
   3. ASA/clopidogrel
      1. Desmopressin (0.3mcg/kg)
      2. Platelets
   4. 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
   5. Dabigatran
      1. rFVIIa 100 mcg/kg
      2. Or PCC 25-50 U/kg
      3. Consider DDAVP 0.3 mcg/kg
      4. Hemodialysis, if feasible