The intracerebral haemorrhage associated to oral anticoagulant therapy: the practical management of urgent reversal therapy

  • Luca Masotti
  • Mario Di Napoli
  • Daniel Godoy
  • Daniela Rafanelli
  • Giancarlo Liumbruno
  • Domenico Prisco
  • Daniela Poli
  • Giancarlo Landini
  • Nicholas Koumpouros
  • Paolo Pennati
  • Alessandro Pampana
  • Roberto Cappelli
Keywords: Vitamin K antagonists, Intracerebral haemorrhage, Warfarin, Fresh frozen plasm, Prothrombin complex concentrate, Recombinant actived Factor VII, OAT reversal


Intracerebral haemorrhage (ICH) represents the most feared complication of therapy with vitamin K antagonists (VKA), so-called oral anticoagulant therapy (OAT). This is a real emergency in clinical practice, being burdened by high mortality, morbidity and residual functional disability. In recent years, there have been widespread indications for the correct management of VKA associated ICH. The urgent OAT reversal represents the cornerstone of VKA associated ICH therapy. The knowledge of these guidelines is of fundamental importance in clinical practice. The urgent OAT reversal could stop the hematoma enlargement which is considered one of the main risk factor of poor outcome in this clinical setting. The aim of urgent OAT reversal is bringing the INR (International Normalized Ratio) to values ≤ 1.4. It is possible by using prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), recombinant activated factor VII (raFVII) together with vitamin K1 intravenous infusion. In this article the Authors review the practical management of urgent OAT reversal in patients suffering for VKA related ICH.

Narrative reviews