Anticoagulation is a medical therapy indicated in diseases such as deep vein thrombosis and atrial fibrillation. The reduction of thrombotic events associated with the implementation of anticoagulation is widely well demonstrated in clinical practice with large-scale studies in populations at risk. Despite the benefit of this treatment, bleeding complications are frequent and intracranial hemorrhage is one of the most serious that can occur. Anticoagulation can be achieved with different medications including warfarin, heparin, and the new direct Factor IIa anticoagulants with different levels of evidence and also associated with bleeding complications. Knowledge of these agents and their pharmacology, their indications, correct dosification, patient's risk factors for central nervous system bleeding, and their treatment, either medical with the specific reversal of the anticoagulant agent involved—when available—or surgical if it is necessary, are the most important interventions in the management of this complication. The emergence of new drugs with safer profiles and high effectiveness requires, as well, epidemiologically strong studies to demonstrate their superiority compared to traditional drugs. Unfortunately, until today, the mortality associated with cerebral hemorrhage, both spontaneous and associated with the use of anticoagulant drugs, continues to be very high and the sequelae of patients who survive in many cases are devastating.