Warfarin-induced intracerebral haemorrhage and the importance of urgent reversal of coagulopathy

Increasing use of warfarin for primary or secondary prevention of ischaemic stroke has led to an increased incidence of warfarin-induced intracerebral haemorrhage (WICH) in recent years. Patients on warfarin have a higher likelihood of having intracerebral haemorrhage, and the morbidity and mortality of WICH are higher than for spontaneous intracerebral haemorrhage. Focal neurological signs in an anticoagulated patient— especially if accompanied by altered consciousness, headache, nausea and vomiting—warrant an urgent brain computerised tomography (CT) scan. WICH is a medical emergency and patients can deteriorate very rapidly. Warfarin reversal should therefore start as soon as possible, as any delay can have catastrophic consequences. Infusion of prothrombin complex concentrates together with intravenous vitamin K is the current recommended treatment for reversal of the anticoagulant effect of warfarin in WICH. The aim of this paper is to increase the awareness of nursing staff regarding this medical emergency and its management.