Template:ICH Treatment
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
- 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