Interested readers are referred to recently published articles for in-depth reviews of these agents. The basic pharmacological properties of commonly used anticoagulants, their mechanism of action, and their indications are presented in Table 1 and Figure 1. In the absence of clinical evidence, definitive guidelines, and proven therapies, clinicians are left scrambling for rapid correction of the coagulopathy and maintaining homeostasis to prevent secondary brain injury. Most clinical data on AICH are related to ICH, while extraparenchymal hemorrhages are reported but data on these are sparse.

AICH can be spontaneous or traumatic, and can occur in different intracranial compartments (for example, subdural hemorrhage, epidural hemorrhage, subarachnoid hemorrhage, or intracerebral hemorrhage (ICH)). The indications for use of anticoagulants are published in a guideline statement by the American College of Chest Physicians, to which readers are referred. Use of anticoagulation therapy among the older western population for varied thromboembolic diseases potentially places them at risk of developing anticoagulant-related intracranial hemorrhage (AICH). This deficit calls for more population-based studies and therapeutic trials to better evaluate risk factors for, and to prevent and treat AICH. Our current state of understanding of this condition and its management is insufficient.

Surgical interventions are options fraught with complications, and are decided on a case-by-case basis. Prothrombin complex concentrates are gaining popularity over fresh frozen plasma, and reversal agents for newer anticoagulation agents are being developed. Supportive care, including blood pressure control, and reversal of anticoagulation remain the cornerstone of acute management of AICH. Although management guidelines for such hemorrhages are available for the older generation anticoagulants, they are still lacking for newer agents, which are becoming popular among physicians. High mortality accompanies this form of hemorrhagic stroke, and significant and debilitating long-term consequences plague survivors. The increased use of anticoagulants for the prevention and treatment of thromboembolic diseases has led to a rising incidence of anticoagulant-related intracranial hemorrhage (AICH) in the aging western population.

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