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Management of warfarin-related intracerebral hemorrhage

William D Freeman1, Maria I Aguilar

  • 1Mayo Clinic Jacksonville, Department of Neurology, Cannaday 2 East, Jacksonville, FL 32224, USA. freeman.william1@mayo.edu

Expert Review of Neurotherapeutics
|February 15, 2008
PubMed

Warfarin-related intracerebral hemorrhage (WICH) is a medical and neurosurgical emergency with a 1-month mortality of approximately 50%. Warfarin is commonly is used in patients with atrial fibrillation to prevent ischemic stroke and to prevent progression of deep vein thrombosis to pulmonary embolism. Owing to the ageing population, and increased incidence of atrial fibrillation with age and warfarin use, the incidence of WICH is expected to rise in the future. When WICH occurs, immediate discontinuation of warfarin with rapid warfarin reversal remains the first-line intervention, often with neurosurgical intervention. The optimal agent for rapid warfarin anticoagulation reversal remains to be defined owing to the lack of prospective randomized trials. We review current literature and prospects for future research for this devastating neurologic emergency.

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