If not already determined by EMS, physicians in the ED should determine the last-seen-normal time in the setting of focal neurologic deficits, although this is less important in the acute management of ICH compared to acute ischemic stroke. It should be ascertained whether the patient is anticoagulated, and what type of anticoagulant the patient is taking. Since warfarin is no longer the only anticoagulant available, emergency clinicians need to be cognizant that patients may present taking direct factor Xa inhibitors or direct thrombin inhibitors. Information about the timing of the last dose of anticoagulant should be determined, especially for NOACs, which (at this time) do not have rapid, accurate tests to determine blood levels.
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