Details

Autor(en) / Beteiligte

• Zemrak, Wesley R.
• Smith, Kathryn E.
• Rolfe, Stephen S.
• May, Teresa
• Trowbridge, Robert L.
• Hayes, Timothy L.
• Grindlinger, Gene A.
• Seder, David B.

Titel

Low-dose Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Hemorrhage with INR Less Than 2.0

Ist Teil von

• Neurocritical care, 2017-12, Vol.27 (3), p.334-340

Ort / Verlag

New York: Springer US

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Prothrombin complex concentrates (PCCs) have become the first-line therapy for warfarin reversal in the setting of central nervous system (CNS) hemorrhage. Randomized, controlled studies comparing agents for warfarin reversal excluded patients with international normalized ratio (INR) <2, yet INR values of 1.6–1.9 are also associated with poor outcomes. Methods We retrospectively reviewed our use of a low-dose (15 units/kg) strategy of 4-factor PCC (4F-PCC) on warfarin reversal (INR 1.6–1.9) in the setting of both traumatic and spontaneous intracranial bleeding. Results A total of 21/134 (15.7%) patients with either spontaneous or traumatic intracranial hemorrhage presented with an INR value of 1.6–1.9. Nine patients (43%) presented with traumatic bleeding and 12 (57%) with spontaneous bleeding. The median (IQR) presenting INR was 1.8 (1.7, 1.9) which decreased to 1.3 (1.2, 1.3) following the administration of low-dose 4F-PCC (median dose = 1062 units; 15.2 units/kg). A total of 19/20 (95%) patients achieved a goal INR value of ≤1.5 on the first check following dosing and 17/20 (85%) achieved an INR value ≤1.3. One patient did not have follow-up INR testing due to withdrawal of life support. No patient experienced hematoma expansion within 48 h of 4F-PCC, and there were no thromboembolic events within 72 h of administration. Conclusions The administration of low dose (15 units/kg) of 4F-PCC for urgent warfarin reversal in the setting of CNS hemorrhage was effective in correcting the INR in patients presenting with INR values of 1.6–1.9. Further assessment of low-dose PCC for urgent reversal of modest INR elevation is warranted.