VKA-related Intracranial Hemorrhage
Unfortunately, even if the INR is well maintained between 2.0 and 3.0, there is still a risk of intracranial hemorrhage (ICH) in patients who are taking vitamin K antagonists. The graph on the left of Figure 10 shows that a rather large proportion of intracranial hemorrhage occurs at the normal INR range.[14] On the right, the graph reminds us that intracranial hemorrhage is of course much more common in the elderly.[15] Camm J. Am J Med 2013; published on-line at http://education.amjmed.com/00000.
References
[14] Berwaerts J, Dijkhuizen RS, Robb OJ, Webster J. Prediction of functional outcome and in-hospital mortality after admission with oral anticoagulant-related intracerebral hemorrhage. Stroke. 2000;31:2558-2562.
[15] Fang MC, Chang Y, Hylek EM, et al. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med. 2004;141:745-752.