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Safety and Efficacy of Warfarin Reversal with Four-Factor Prothrombin Complex Concentrate for Subtherapeutic INR in Intracerebral Hemorrhage

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Abstract

Background

The use of vitamin K antagonists is an independent risk factor for the development of intracerebral hemorrhage (ICH). Four-factor prothrombin complex concentrate (4F-PCC) is recommended for urgent reversal of anticoagulation in this setting. The safety and efficacy of 4F-PCC in ICH with subtherapeutic levels of anticoagulation is yet to be determined.

Methods

This was a retrospective, observational study of 4F-PCC administration data from September 2013 to July 2015. Patients with spontaneous or traumatic ICH with initial INR 1.4–1.9 were compared to those with INR 2–3.9. A Fisher’s exact test was used to compare the difference between the two groups in the effectiveness of 4F-PCC in reversing the INR to ≤1.3 and in the occurrence of thrombotic events within 7 days of administration.

Results

A total of 131 patients with a presenting INR between 1.4 and 3.9 received 4F-PCC during the study period. Twenty-three of 29 patients (79 %) in the INR <2 group achieved an INR reduction to ≤1.3 after 4F-PCC administration compared to 47 of 92 patients (51 %) in the INR 2–4 group, p = 0.03. There was no difference in thrombotic complications within 7 days after administration (6.7 % in INR 1.4–1.9 group, 10 % in INR 2–3.9 group, p = 0.73).

Conclusion

The use of 4F-PCC in patients with INR between 1.4 and 1.9 results in an effective reduction in INR with similar thrombotic risks compared to patients presenting with an INR of 2–3.9.

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Authors and Affiliations

  1. Department of Pharmacy, UPMC Presbyterian Hospital, Pittsburgh, PA, USA

    Ryan M. Rivosecchi & Joseph Durkin

  2. Department of Neurologic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    David O. Okonkwo

  3. Departments of Neurology and Critical Care Medicine, University of Pittsburgh, 3501 Fifth Avenue, BST3-7021, Pittsburgh, PA, 15213, USA

    Bradley J. Molyneaux

Authors
  1. Ryan M. Rivosecchi
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  2. Joseph Durkin
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  3. David O. Okonkwo
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  4. Bradley J. Molyneaux
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Correspondence to Bradley J. Molyneaux.

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Rivosecchi, R.M., Durkin, J., Okonkwo, D.O. et al. Safety and Efficacy of Warfarin Reversal with Four-Factor Prothrombin Complex Concentrate for Subtherapeutic INR in Intracerebral Hemorrhage. Neurocrit Care 25, 359–364 (2016). https://doi.org/10.1007/s12028-016-0271-9

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