Neurocritical Care

, Volume 21, Issue 3, pp 397–406

Reversal of Coagulopathy Using Prothrombin Complex Concentrates is Associated with Improved Outcome Compared to Fresh Frozen Plasma in Warfarin-Associated Intracranial Hemorrhage

  • Jennifer A. Frontera
  • Errol Gordon
  • Victor Zach
  • Maximo Jovine
  • Ken Uchino
  • Muhammad S. Hussain
  • Louis Aledort
Original Article

DOI: 10.1007/s12028-014-9972-0

Cite this article as:
Frontera, J.A., Gordon, E., Zach, V. et al. Neurocrit Care (2014) 21: 397. doi:10.1007/s12028-014-9972-0

Abstract

Background

There are no studies demonstrating that prothrombin complex concentrates (PCC) improves outcome compared FFP in patients with warfarin-associated intracranial hemorrhage.

Methods

A prospective, observational study was conducted of patients who received PCC (Bebulin VH), FFP, or PCC + FFP. All groups received vitamin K 10 mg IV. INR reversal (<1.4), adverse events (venous thromboembolism, myocardial infraction, pulmonary edema), major hemorrhage (new or worsened intracranial hemorrhage, anemia requiring transfusion or GI bleed), and 3-month functional outcome were compared between the groups using Chi squared and logistic regression analysis.

Results

Of 64 patients, PCC alone was used in 16 (mean dose 48 IU/kg), FFP alone in 25 (mean dose 12.5 ml/kg), and PCC + FFP in 23 (median doses 47.4 IU/kg and 11.4 ml/kg, respectively). INR correction occurred in 88, 84, and 70 %, respectively. There were no differences in time to INR correction or adverse events between the groups, but FFP alone was associated with more major hemorrhage after administration (52 %, OR 5.0, 95 % CI 1.6–15.4, P = 0.006) and PCC with less (6 %, OR 0.1, 95 % CI 0.01–0.8, P = 0.033). After adjusting for age, admission GCS, initial INR, and bleed type, the use of PCC was associated with a lower risk of death or severe disability at 3-months (adjusted OR 0.02, 95 % CI 0.001–0.8, P = 0.039), while FFP alone was associated with a higher risk (adjusted OR 51.6, 95 % CI 1.2–2163.1, P = 0.039).

Conclusions

PCC adequately corrected INR without any increase in adverse events compared to FFP and was associated with less major hemorrhage and improved 3-month outcomes in patients with warfarin-associated intracranial hemorrhage.

Keywords

Warfarin reversalIntracranial hemorrhageWarfarin-associated ICHPCCProthrombin complex concentratesOutcomeFresh frozen plasmaFFPPlasmaHemostasis

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jennifer A. Frontera
    • 1
  • Errol Gordon
    • 2
  • Victor Zach
    • 2
  • Maximo Jovine
    • 2
  • Ken Uchino
    • 1
  • Muhammad S. Hussain
    • 1
  • Louis Aledort
    • 3
  1. 1.Cerebrovascular Center of the Neurological InstituteCleveland Clinic FoundationClevelandUSA
  2. 2.Neuroscience Intensive Care Unit, Departments of Neurosurgery and NeurologyMount Sinai School of MedicineNew YorkUSA
  3. 3.Hematology Division, Department of MedicineMount Sinai School of MedicineNew YorkUSA