Abstract
Patients treated with oral anticoagulants (OAC) carry a 7- to 10-fold higher risk
of intracerebral hemorrhage (ICH) than patients without OAC. ICH related to oral anticoagulation
(OAC-ICH) is a particularly severe form of stroke. The overall incidence of OAC-ICH
ranges between 2 and 9 per 100,000 population/year and is expected to increase as
the number of patients treated with OAC rises. Besides common risk factors of ICH
such as age and hypertension, the intensity of anticoagulation, previous ischemic
stroke, and the presence of cerebral vasculopathies (e.g., amyloid angiopathy, subcortical
hypertensive arteriopathy) are associated with a greater risk of OAC-ICH. Mortality
rates in OAC-ICH of 52 to 67% considerably exceed those of ICH in nonanticoagulated
patients. Factors that mediate worse outcome in OAC-ICH are more frequent and prolonged
secondary hematoma enlargement and intraventricular hemorrhage, The current concept
of emergency treatment in OAC-ICH is rapid restoration of effective coagulation using
hemostatic factors such as prothrombin complex concentrate, fresh frozen plasma, factor
IX concentrates, and recombinant factor VIIa in addition to vitamin K. Emergency management
of ICH under treatment with the new direct OAC is a major challenge. In the absence
of specific antidotes, prothrombin concentrates are recommended mainly on the basis
of preclinical data.
Keywords
intracerebral hemorrhage - warfarin - oral anticoagulation
