Hemostasis, the physiological response to vascular injury, results from activation of a highly regulated series of procoagulant and anticoagulant zymogens and cofactors. This chapter reviews hemostatic abnormalities reported in patients with intracerebral hemorrhage (ICH). It discusses pharmacological strategies for prevention of hematoma expansion in both coagulopathic and non-coagulopathic ICH. Intracerebral and intraventricular hemorrhage appears to be associated with subtle abnormalities of blood coagulation, platelet function, and fibrinolysis, and there is some evidence that these abnormalities may be more pronounced in patients with more extensive hemorrhage. The rationale for hemostasis manipulation in ICH is to stop rebleeding in the acute phase thus preventing hematoma enlargement. In the modern era of acute stroke intervention, effective medical management to correct coagulopathies and prevent further bleeding from ICH should be developed just as has been accomplished for acute ischemic stroke.