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Neurology
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Intracranial Hemorrhage Management
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Reverse anticoagulation + BP control + ICP management.
Decision
Outcome
Decision
Intracranial hemorrhage on CT. First steps?
✓
Reverse anticoagulation (per agent), BP control to systolic 140, neurosurgery consult
✗
IV tPA
Decision
Specific reversal — which agent?
✓
Warfarin → 4-factor PCC + vitamin K
✓
Dabigatran → idarucizumab
✓
Apixaban/rivaroxaban → andexanet alfa or 4F-PCC
✓
Heparin → protamine sulfate
Outcome
Manage ICP (HOB ↑30°, mannitol/hypertonic saline, sedation); surgical evacuation if cerebellar bleed >3 cm or worsening
Avoid prophylactic anticonvulsants unless seizure occurs.