Intracranial haemorrhage is an infrequent but often fatal complication
of oral anticoagulant therapy which will become more common as antico
agulant use increases. The risk of anticoagulant-induced intracranial
haemorrhage may be reduced by judicious prescribing, identification of
patients at high risk of bleeding, and close monitoring by experience
d staff, The presenting features of intracranial haemorrhage are often
vague and physicians should be aware of the need for urgent investiga
tion of all anticoagulated patients with neurological symptoms. Curren
t guidelines for immediate reversal of anticoagulation recommend admin
istration of vitamin K-1 and factor replacement with either factor con
centrates or fresh frozen plasma. In this review we discuss recent evi
dence suggesting prothrombin complex concentrates lead to faster, and
more complete, correction of coagulation and, in the context of intrac
ranial bleeding, may be associated with improved neurological status.
Evidence for the risks of short-term cessation of anticoagulants, in t
he immediate period following an intracranial haemorrhage, and their s
ubsequent reintroduction is also discussed.