Activated prothrombin complex concentrate for warfarin reversal in traumatic intracranial hemorrhage
| Autor: | Chancey Carothers, Amanda Giancarelli, Brandon Hobbs, Joseph A Ibrahim |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Vial 03 medical and health sciences 0302 clinical medicine medicine Humans International Normalized Ratio Aged Retrospective Studies Aged 80 and over Abbreviated Injury Scale business.industry Standard treatment Warfarin 030208 emergency & critical care medicine Retrospective cohort study medicine.disease Thrombosis Prothrombin complex concentrate Blood Coagulation Factors Intracranial Hemorrhage Traumatic Anesthesia Female Surgery Fresh frozen plasma business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of Surgical Research. 223:183-187 |
| ISSN: | 0022-4804 |
| Popis: | Patients with traumatic intracranial hemorrhage (TIH) anticoagulated with warfarin are at an increased risk of mortality. Fresh frozen plasma (FFP) and vitamin K have been the standard treatment for warfarin reversal; however, guidelines now recommend the use of prothrombin complex concentrate (PCC) for warfarin reversal in patients with life-threatening bleeding. Our protocol uses one vial (∼1000 units) of activated PCC (aPCC) for warfarin reversal, regardless of the weight or presenting international normalized ratio (INR). The purpose of this study was to determine the safety and efficacy of using fixed, low-dose aPCC for warfarin reversal in patients with TIH.This was a retrospective chart review that included patients with an Abbreviated Injury Scale Head score of ≥3, TIH, and initial INR ≥ 1.5 on warfarin. Patients aged18 years and those with no repeat INR were excluded. The primary outcome was to compare the percentage of patients with INR ≤ 1.4 after receiving aPCC versus FFP within 24 hours.Eighty-nine patients were in the FFP group and 31 patients in the aPCC group. The INR was reversed more effectively in the aPCC group compared with the FFP group (90.3% versus 69.7%, P = 0.029). The median time (hours) to reversal was also significantly shorter in the aPCC group compared with the FFP group (3.75 versus 6.75, P = 0.003). However, there was no difference in mortality (35.5% aPCC versus 22.2% control, P = 0.162) or incidences of thrombosis.Fixed, low-dose aPCC is safe and more effective at reversing the effects of warfarin than FFP in patients with TIH. |
| Databáze: | OpenAIRE |
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