Coagulopathies

The presence of an associated coagulopathy in the setting of ICH complicates the management of these patients, not only by facilitating hematoma enlargement but also by preventing or delaying emergent invasive procedures, such as the placement of intraventricular catheters (IVC) for ICP monitoring and treatment of obstructive hydrocephalus. Coagulopathies could also delay any emergent surgical treatment in these patients. The most common cause of coagu-lopathy in the setting of ICH remains the use of systemic anticoagulation. It becomes critical that the coagulopathy be reversed emergently by using fresh frozen plasma and vitamin K to normalize prolongation of the International Normalized Ratio (INR) to < 1.4, with plasma producing a faster, albeit shorter, lasting effect.

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