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Effectiveness of Factor IX Complex Concentrate in Reversing Warfarin Associated Coagulopathy for Intracerebral Hemorrhage

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Abstract

Introduction

The objective of this study is to show the effectiveness of Factor IX complex concentrate (FIXCC) for rapid reversal of an elevated International Normalized Ratio (INR) in patients with anticoagulation-associated intracerebral hemorrhage (AAICH).

Methods

We, retrospectively, analyzed the clinical data of 19 patients with the diagnosis of AAICH from January 2005 to May 2006. A comparison was made among patients treated with FFP and Vit.K [FFP-group (n = 9)] and patients treated with FIXCC in addition to FFP and Vit.K [FIXCC-group (n = 10)]. INR of 1.4 or less was taken as target.

Results

Mean INR on admission for FFP and FIXCC group was 1.84 ± 0.31 and 2.44 ± 1.48, respectively (P = 0.315). After administration of therapy, the INR was reduced from 1.84 ± 0.31 to 1.34 ± 0.08 (P < 0.05) in FFP group and 2.44 ± 1.48 to 1.34 ± 0.07 (P < 0.005) in FIXCC group. Three patients in FFP group (33%) and 8 patients in FIXCC group (80%) reached their target INR in 3–4 h after initiation of therapy (P = 0.012). Mean time taken by both FFP and FIXCC groups to reach the target INR was 8.52 ± 5.60 h and 4.25 ± 2.12 h, respectively (P < 0.05). The mean rate of INR correction was 0.06 ± 0.03 and 0.27 ± 0.25 per hour for the FFP and FIXCC group, respectively (P < 0.005). There was one death in FIX group and two in FFP group and no thrombotic complications.

Conclusion

Our data suggests that FIXCC in combination with FFP and Vit.K may result in decreased time required when compared to FFP and Vit.K alone for correction of warfarin associated coagulopathy in neurosurgical emergencies.

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Authors and Affiliations

  1. Department of Neurology, Thomas Jefferson University, 900 Walnut Street, Suite 200, Philadelphia, PA, 19107, USA

    Farhan Siddiq, Abdul Jalil, Cara McDaniel, David G. Brock, Carissa C. Pineda & Rodney D. Bell

  2. Neurology and Neurological Surgery, Critical Care Division, Neurological Institute, Columbia University College of Physicians and Surgeons, New York Presbyterian – Columbia University Medical Center, 710W. 168th Street, New York, NY, 10032, USA

    Kiwon Lee

Authors
  1. Farhan Siddiq
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  2. Abdul Jalil
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  3. Cara McDaniel
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  4. David G. Brock
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  5. Carissa C. Pineda
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  7. Kiwon Lee
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Correspondence to Kiwon Lee.

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Siddiq, F., Jalil, A., McDaniel, C. et al. Effectiveness of Factor IX Complex Concentrate in Reversing Warfarin Associated Coagulopathy for Intracerebral Hemorrhage. Neurocrit Care 8, 36–41 (2008). https://doi.org/10.1007/s12028-007-9011-5

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