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Intracerebral hemorrhage on anticoagulation — ABEM Board MCQ

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HardNeurological emergenciesIntracerebral hemorrhage on anticoagulationABEM Board

A 74-year-old man taking warfarin arrives with sudden left hemiparesis and vomiting. Triage acuity is ESI 2; BP 204/108 mm Hg, HR 86/min. CT head shows right basal ganglia hemorrhage with mild midline shift. INR is 3.4. Which of the following is the most appropriate next step in management?

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Correct answer: B — Reverse warfarin with 4-factor PCC and IV vitamin K while controlling blood pressure

Warfarin-associated intracerebral hemorrhage requires rapid reversal with PCC and vitamin K plus blood pressure management.

Reference: AHA/ASA intracerebral hemorrhage guideline