Haemorrhagic stroke

Approximately 10% of strokes are bleeds.

These are time critical situations to manage.

Patients with ICH on CT scan must have Blood pressure taken and acted upon early. We aim to decrease Blood pressure to target of 140 systolic within 1 hour of arrival. We use GTN or labetalol. Stroke Guidance Posters [pdf] 660KB

Patients with ICH on anticoagulation must have the anticoagulation reversed as soon as possible. ED has point of care INR Initial treatment is with vitamin K 10mg IV and then tranexamic acid (with caution in patients with history of thrombosis). Prothrombin concentrate (Octaplex, Beriplex) in cases of patients on warfarin or Factor Xa inhibitors (Apixaban, Rivaroxaban, Edoxaban) We have access to Idaricizumab for patients with ICH on Dabigatran. Again, we aim to have to have reversal of anticoagulation within 1 hour of arrival.  Management of Intracerebral Haemorrhages [pdf] 450KB

Surgical referral may be required in some cases of haemorrhagic stroke. Often, it depends on where the bleed is and whether there is issue with raised intracranial pressure. These are discussed on a case-by-case basis. The referrals are done via the refer a patient app. 

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