Cerebral Hemorrhage and High INR

A significant number of individuals use anticoagulants, especially coumarins, in order to prevent cardio- and cerebrovascular diseases. Intracerebral hemorrhage is a cerebrovascular emergency with a lower incidence than ischemic stroke but with higher morbidity and mortality. In this population, the rapid diagnosis and INR reversal is paramount to prevent hematoma expansion and improve outcomes. Neurosurgical procedures, when well indicated, can benefit these patients if performed with adequate hematological parameters. Currently, there are no universal accepted guidelines on treatment. In this review, we detail pathophysiology, pharmacology of coumarins, medical treatment, neurosurgical treatment, and prognosis. It represents a guide of how to manage intracerebral hemorrhage related to oral anticoagulant therapy.