Acute Spontaneous Intracerebral Hemorrhage (ICH) Management — free guideline decision tool

From systolic pressure, anticoagulation relation and surgical indication, give the BP target, anticoagulation-reversal and neurosurgical direction for spontaneous ICH. Instant, browser-side.

SBP 150–220 → smoothly lower to a target of 140 (maintain 130–150, avoid < 130); SBP > 220 → continuous IV antihypertensive with close monitoring. Anticoagulation-related → stop and reverse at once. Cerebellar hemorrhage > 3 cm / brainstem compression / hydrocephalus / herniation → emergency neurosurgery.

Initial management framing of acute spontaneous intracerebral hemorrhage.

Start BP control within 2 h and reach target within 1 h, avoiding large fluctuations; do not lower SBP below 130 (harmful). Reverse anticoagulation without waiting for labs — agent-specific (VKA: vitamin K + 4F-PCC; dabigatran: idarucizumab; Xa inhibitor: andexanet or 4F-PCC; heparin: protamine); do not routinely transfuse platelets. Cerebellar hemorrhage > 3 cm or with brainstem compression/hydrocephalus needs urgent posterior-fossa decompression/EVD. Antiseizure drugs only for clinical seizures (not prophylactic); intermittent pneumatic compression for early VTE prophylaxis.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Systolic blood pressure (SBP) 180 mmHg, Anticoagulation-related Yes, Cerebellar hemorrhage > 3 cm / brainstem compression / hydrocephalus / mass effect with herniation Yes → Result: Action BP control + anticoagulation reversal（Blood-pressure management: SBP 150–220 mmHg (mild-moderate ICH): smoothly lower to a target of 140 mmHg (maintain 130–150) — safe and improves functional outcome; avoid lowering < 130 (harmful); start within 2 h, reach target within 1 h, avoid large fluctuations, Anticoagulation reversal (urgent): Anticoagulation-related ICH: stop the anticoagulant immediately and reverse as fast as possible (do not wait for labs — improves survival) — VKA with vitamin K + 4F-PCC, dabigatran with idarucizumab, Xa inhibitors with andexanet or 4F-PCC, heparin with protamine (see the anticoagulation-reversal tool); do not routinely transfuse platelets, Surgery (emergency): Cerebellar hemorrhage > 3 cm or with neurological deterioration/brainstem compression/hydrocephalus, or mass effect with herniation: urgent neurosurgical consult — posterior-fossa decompression with hematoma evacuation, external ventricular drainage for hydrocephalus; supratentorial hematoma surgery individualised (including new evidence for minimally invasive evacuation)） Inputs: Systolic blood pressure (SBP) 180 mmHg, Anticoagulation-related No, Cerebellar hemorrhage > 3 cm / brainstem compression / hydrocephalus / mass effect with herniation No → Result: Action Smooth BP control + support（Blood-pressure management: SBP 150–220 mmHg (mild-moderate ICH): smoothly lower to a target of 140 mmHg (maintain 130–150) — safe and improves functional outcome; avoid lowering < 130 (harmful); start within 2 h, reach target within 1 h, avoid large fluctuations, General/supportive: Neurological and ICP monitoring, head-of-bed elevation, analgesia-sedation, glucose and temperature management; antiseizure drugs only for clinical seizures (not prophylactic); intermittent pneumatic compression for VTE prophylaxis, low-dose pharmacologic prophylaxis once stable, ICP lowering: Mass effect/herniation signs: osmotherapy (mannitol or hypertonic saline) with neurosurgical assessment）