Document Detail

Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy: comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates.
MedLine Citation:
PMID:  16675739     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) is the most serious and potentially fatal complication of oral anticoagulant therapy (OAT). Still, there are no universally accepted treatment regimens for patients with OAT-ICH, and randomized controlled trials do not exist. The aim of the present study was to compare the acute treatment strategies of OAT-associated ICH using vitamin K (VAK), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) with regard to hematoma growth and outcome. METHODS: In this retrospective study, a total of 55 treated patients were analyzed. Three groups were compared by reviewing the clinical, laboratory, and neuroradiological parameters: (1) patients who received PCCs alone or in combination with FFP or VAK (n=31), (2) patients treated with FFP alone or in combination with VAK (n=18), and (3) patients who received VAK as a monotherapy (n=6). The end points of early hematoma growth and outcome after 12 months were analyzed including multivariate analysis. RESULTS: Hematoma growth within 24 hours occurred in 27% of patients. Incidence and extent of hematoma growth were significantly lower in patients receiving PCCs (19%/44%) compared with FFP (33%/54%) and VAK (50%/59%). However, this effect was no longer seen between PCC- and FFP-treated patients if international normalized ratio (INR) was completely reversed within 2 hours after admission. The overall outcome was poor (modified Rankin scale 4 to 6 in 77%). Predictors for hematoma growth were an increased INR after 2 hours, whereas administration of PCCs was significantly protective in multivariate analyses. Predictors for a poor outcome were age, baseline hematoma volume, and occurrence of hematoma growth. CONCLUSIONS: Overall, PCC was associated with a reduced incidence and extent of hematoma growth compared with FFP and VAK. This effect seems to be related to a more rapid INR reversal. Randomized controlled trials are needed to identify the most effective acute treatment regimen for lasting INR reversal because increased levels of INR were predisposing for hematoma enlargement.
Hagen B Huttner; Peter D Schellinger; Marius Hartmann; Martin Köhrmann; Eric Juettler; Johannes Wikner; Stephan Mueller; Uta Meyding-Lamade; Ralf Strobl; Ulrich Mansmann; Stefan Schwab; Thorsten Steiner
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Publication Detail:
Type:  Journal Article     Date:  2006-05-04
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  37     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-05-29     Completed Date:  2006-06-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1465-70     Citation Subset:  IM    
Department of Neurology, University of Heidelberg, Germany.
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MeSH Terms
Administration, Oral
Anticoagulants / administration & dosage,  adverse effects*
Blood Coagulation Factors / therapeutic use*
Blood Component Transfusion*
Cerebral Hemorrhage / chemically induced,  diagnosis,  therapy*
Critical Care*
Hematoma / chemically induced,  diagnosis,  therapy*
Magnetic Resonance Imaging
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Vitamin K / therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 0/Blood Coagulation Factors; 12001-79-5/Vitamin K; 37224-63-8/prothrombin complex concentrates

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