Fatal Intracranial Hemorrhage Associated with Oral Warfarin Use

Intracerebral hemorrhage is the most devastating complication in patients taking oral warfarin. Despite theoretic reversibility with fresh frozen plasma, vitamin K and prothrombin complex concentrate, it remains an entity with high mortality. Fluid-fluid level, also known as blood-fluid level, sedimentation level, or hematocrit effect, seen on noncontrast computed tomography (CT) scan is a characteristic finding associated with patients who have coagulopathy or who are receiving oral anticoagulation therapy. We present the case of an 80-year-old female patient requiring long-term anticoagulation due to atrial fibrillation, who presented acute neurological symptoms including thunderclap headache and hemiparesis. Urgent noncontrast CT scan showed classic signs of warfarin-induced intracranial hemorrhage with a fatal outcome a few hours after admission.