Challenging Management of Warfarinised Patients with Intracranial Hemorrhage Following a Head Injury: A Major Medical Dilemma

Document Type : Review Article


1 Cardiologist, Fellowship of Echocardiography, Preventive Cardiovascular Care Research Center, Faculty of medical science, Mashhad University of Medical Sciences, Mashhad, Iran

2 Cardiac Surgeon, Department of Cardiac Surgery, Faculty of Medical Sciences, Farshchian Heart Center, Hamedan University of Medical Sciences, Hamedan, Iran

3 Cardiac Surgeon, Department of Cardiac Surgery, Faculty of Medical Sciences. Mashhad University of Medical Sciences, Mashhad, Iran

4 General Physician, Faculty of Medical Science, Mashhad University of Medical Sciences, Mashhad, Iran

5 Student Research Committee, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad

6 Cardiac Surgeon, Department of Cardiac Surgery, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad. Iran


Introduction:The use of anticoagulant and ant platelet medications, especially warfarin and clopidogrel, is on a growing trend. Warfarin usage is commonly accompanied with hemorrhagic complications resulting in a noticeable mortality rate. Patient's ant coagulated with warfarin suffers from intracranial hemorrhage after a head injury.
Materials and Methods: For the purpose of the study, the relevant articles published from 1966 to January 2017 were searched in several databases, including of Medline, Scopus, Google Scholar, and MEDLINE (through PubMed). The search process was performed using the following medical subject headings: “Warfarin” combined with “Warfarin-associated hemorrhage”, “Head injury and warfarin-related intracranial hemorrhage”, “Intracerebral hemorrhage”, and “Treatment of coagulopathy”.
Results: The search process resulted in the inclusion of 242 articles. According to the results of the reviewed studies, the best treatments for the reversal of coagulopathy in warfarinised patients in elective or urgent conditions following a head injury are prothrombin complex concentrate (PCC) and fresh frozen plasma, along with vitamin K, based on the discretion of the treating physician.
Conclusion: According to the studies, the administration of PCC or any other treatments with a similar or close formulation to PCC is significantly more effective and faster in the reversal of coagulopathy and reduction of international normalized ratio in comparison with the use of fresh frozen plasma or other therapies in warfarinised patients admitted with serious intracranial hemorrhage following a head injury. Delivery of an effective treatment to these patients can be accomplished by planning for medical interventions, decreasing time delays for operations, and selecting a suitable or alternative treatment.


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