Abstract
A hematology/thrombosis consultation for a patient admitted with warfarin-associated intracerebral hemorrhage (ICH) should take into account the indication for anticoagulation, the treatment history with warfarin, any possible precipitating risk factors for the hemorrhage, the location of the hematoma, and the condition of the patient. Finally, the balance between the risk for ischemic stroke without anticoagulation and the risk of recurrent ICH with resumed anticoagulation should be assessed. Until recently, expert opinion1 as well as systematic reviews2,3 were favoring early resumption, that is, after 3 to 14 days, of anticoagulation in stable patients. A retrospective study of 234 patients with warfarin-associated ICH concluded that the resumption should be delayed by 10 to 30 weeks to avoid the early high-risk period for recurrent hemorrhage, during which full anticoagulation appeared to increase this risk 5-fold.4 In risk modeling, it could be calculated from the data in this study that resumption of warfarin after 1 month …
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