Timing of INR reversal using fresh-frozen plasma in warfarin-associated intracerebral hemorrhage
| Autor: | Christopher D. Anderson, Anand Viswanathan, Mahmut Edip Gurol, Murtaza Akhter, Abigail S. Cohen, Andrea Morotti, Jonathan Rosand, Alison M. Ayres, Yuchiao Chang, Steven M. Greenberg, Joshua N. Goldstein, Kristin Schwab |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Vitamin K Blood Component Transfusion 030204 cardiovascular system & hematology Statistics Nonparametric Cohort Studies Plasma 03 medical and health sciences 0302 clinical medicine Hematoma Modified Rankin Scale health services administration Internal Medicine medicine Coagulopathy Humans International Normalized Ratio cardiovascular diseases Stroke Aged Cerebral Hemorrhage Retrospective Studies Aged 80 and over Intracerebral hemorrhage Chi-Square Distribution business.industry Warfarin Anticoagulants Middle Aged medicine.disease Antifibrinolytic Agents Treatment Outcome Massachusetts Anesthesia Cohort Emergency Medicine Female Fresh frozen plasma Tomography X-Ray Computed business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Internal and Emergency Medicine. 13:557-565 |
| ISSN: | 1970-9366 1828-0447 |
| Popis: | Rapid reversal of coagulopathy is recommended in warfarin-associated intracerebral hemorrhage (WAICH). However, rapid correction of the INR has not yet been proven to improve clinical outcomes, and the rate of correction with fresh-frozen plasma (FFP) can be variable. We sought to determine whether faster INR reversal with FFP is associated with decreased hematoma expansion and improved outcome. We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with WAICH presenting to an urban tertiary care hospital from 2000 to 2013. Patients with baseline INR > 1.4 treated with FFP and vitamin K were included. The primary outcomes are occurrence of hematoma expansion, discharge modified Rankin Scale (mRS), and 30-day mortality. The association between timing of INR reversal, ICH expansion, and outcome was investigated with logistic regression analysis. 120 subjects met inclusion criteria (mean age 76.9, 57.5% males). Median presenting INR was 2.8 (IQR 2.3–3.4). Hematoma expansion is not associated with slower INR reversal [median time to INR reversal 9 (IQR 5–14) h vs. 10 (IQR 7–16) h, p = 0.61]. Patients with ultimately poor outcome received more rapid INR reversal than those with favorable outcome [9 (IQR 6–14) h vs. 12 (8–19) h, p = 0.064). We find no evidence of an association between faster INR reversal and either reduced hematoma expansion or better outcome. |
| Databáze: | OpenAIRE |
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