The AHA/ASA just published updated guidelines for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage (ICH).
Regarding hemostatic therapy, new/revised recommendations from the 2007 AHA/ASA guidelines include:
Patients with severe thrombocytopenia or factor deficiency should receive platelets or factor replacement
Patients with ICH due to oral anticoagulants (warfarin) should receive intravenous vitamin-K and vitamin-K dependent factor replacement
Prothrombin complex concentrates (PCCs) are being increasingly used and are considered a reasonable alternative to FFP. To date, studies have not shown improved outcome with PCCs.
Recombinant factor VIIa (rFVIIa) is not recommended as a sole agent for warfarin-related ICH
rFVIIa is not recommended in unselected patients
Usefulness of platelet transfusions for patients using antiplatelet medications is unclear and currently investigational.
References
Morgenstern LB, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke 2010;41:00-00.
