Neurocritical Care

, Volume 27, Issue 1, pp 51–59 | Cite as

Safety and Effectiveness of Factor VIII Inhibitor Bypassing Activity (FEIBA) and Fresh Frozen Plasma in Oral Anticoagulant-Associated Intracranial Hemorrhage: A Retrospective Analysis

  • Ellen B. Yin
  • Benedict Tan
  • Thuy Nguyen
  • Miguel Salazar
  • Kimberly Putney
  • Pramod Gupta
  • Jose I. Suarez
  • Eric M. Bershad
Original Article



Oral anticoagulant (OAT)-associated intracranial hemorrhage (ICH) is a life-threatening emergency for which prothrombin complex concentrates (PCC) are considered first-line reversal agents. The only approved PCC in the USA for warfarin-associated ICH is non-activated PCC. Little data are available regarding the safety and effectiveness of factor VIII inhibitor bypassing activity (FEIBA) which is an activated prothrombin complex concentrate (aPCC). The aim of this analysis was to assess the safety and effectiveness of FEIBA compared to fresh frozen plasma (FFP) for reversal of OAT-associated ICH.


Data were retrospectively collected to compare coagulation markers and in-hospital clinical outcomes in patients who received aPCC with or without FFP versus FFP alone for the reversal of OAT-associated ICH.


Eighty-four patients met inclusion criteria; 50 patients received FFP alone, and 34 patients received FEIBA (mean dose 20 U/kg) with or without FFP for OAT-associated ICH. The proportion of diagnosed thrombotic events during hospitalization was similar in both groups (8% in the FFP group vs. 12% in the FEIBA group; P = 0.56). Median time to INR < 1.5 was achieved faster in the FEIBA group versus the FFP group (0.5 h [IQR 0.5–1.] vs. 10 h [IQR 5–16.3], respectively; P < 0.001) reflecting a trend toward shorter median time to neurosurgical intervention. Hematoma expansion, length of stay, and all-cause mortality were similar between both groups.


Administration of FEIBA does not appear to increase the risk of thrombotic events compared with FFP. FEIBA administration resulted in faster INR reversal with a trend toward shorter time to neurosurgical intervention. However, there was no difference in hematoma expansion, mortality or length of stay.


Factor VIII inhibitor bypassing activity (FEIBA) Activated prothrombin complex concentrate Fresh frozen plasma Warfarin Intracranial hemorrhage Oral anticoagulant reversal 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Ellen B. Yin
    • 1
  • Benedict Tan
    • 2
  • Thuy Nguyen
    • 1
  • Miguel Salazar
    • 1
  • Kimberly Putney
    • 1
  • Pramod Gupta
    • 2
  • Jose I. Suarez
    • 2
  • Eric M. Bershad
    • 2
  1. 1.CHI St. Luke’s Health - Baylor St. Luke’s Medical CenterHoustonUSA
  2. 2.Baylor College of MedicineHoustonUSA

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