From: Clinical review: Critical care management of spontaneous intracerebral hemorrhage
Scenario | Agent | Dose | Comments | Level of Evidence* |
---|---|---|---|---|
Warfarin | Fresh frozen plasma | 15 ml/kg | Usually 4 to 6 units (200 ml) each are given | B |
 | or |  |  |  |
 | Prothrombin complex concentrate | 15 to 30 U/kg | Works faster than fresh frozen plasma, but carries risk of disseminated intravascular coagulation | B |
 | and |  |  |  |
 | Intravenous vitamin K | 10 mg | Can take up to 24 hours to normalize international normalized ratio | B |
Warfarin and emergency neurosurgical intervention | Above plus rFVIIa | 20 to 80 μg/kg | Contraindicated in acute thromboembolic disease | C |
Unfractionated or low molecular weight heparin†| Protamine sulfate | 1 mg per 100 units of heparin, or 1 mg of enoxaparin | Can cause flushing, bradycardia, or hypotension, anticoagulation | C |
Platelet dysfunction or thrombocytopenia | Platelet transfusion | 6 units | Range 4 to 8 units based on size; transfuse to >100,000 | C |
 | and/or |  |  |  |
 | Desmopressin (DDAVP) | 0.3 μg/kg | Single dose required | C |