Warfarin-associated intracerebral hemorrhage is inadequately treated at community emergency departments

Stroke. 2012 Sep;43(9):2503-5. doi: 10.1161/STROKEAHA.112.664540. Epub 2012 Jul 5.


Background and purpose: The purpose of this study was to investigate time delays, adherence to guidelines, and their impact on outcomes in patients with warfarin-associated intracerebral hemorrhage transferred from community emergency departments to a comprehensive stroke center.

Methods: We collected demographic, clinical, transfer time, treatment, and outcome data for patients transferred to our institution with warfarin-associated intracerebral hemorrhage from community emergency departments.

Results: Among 928 patients with intracerebral hemorrhage, 56 (6%) with warfarin-associated intracerebral hemorrhage (median international normalized ratio, 2.55) were transferred to the comprehensive stroke center. Twenty patients received no acute reversal therapy before transfer, only 4 of whom had international normalized ratios ≤1.4 in the community emergency department. Median time of emergency department stay was 3.66 hours and median time to initiation of acute reversal therapy was 4.48 hours. Those who received ≥3 U of fresh-frozen plasma or recombinant activated Factor VIIa (11 patients) before transfer had lower repeat international normalized ratios and better discharge dispositions than those treated less aggressively.

Conclusions: Treatment of warfarin-associated intracerebral hemorrhage in community emergency departments is often suboptimal and does not adhere to published guidelines. Treating coagulopathy aggressively before interhospital transfer may improve outcomes and warrants further investigation.

MeSH terms

  • Aged
  • Anticoagulants / adverse effects*
  • Anticoagulants / antagonists & inhibitors
  • Cerebral Hemorrhage / chemically induced*
  • Cerebral Hemorrhage / mortality
  • Cerebral Hemorrhage / therapy*
  • Community Health Centers*
  • Emergency Medical Services*
  • Emergency Service, Hospital*
  • Factor VIIa / therapeutic use
  • Female
  • Hospital Mortality
  • Humans
  • International Normalized Ratio
  • Male
  • Plasma
  • Registries
  • Time Factors
  • Warfarin / adverse effects*
  • Warfarin / antagonists & inhibitors


  • Anticoagulants
  • Warfarin
  • Factor VIIa