| Rapid warfarin reversal: a 3-factor prothrombin complex concentrate and recombinant factor VIIa cocktail for intracerebral hemorrhage. | |
| | |
MedLine Citation:
|
PMID: 22175718 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
Object Intracerebral hemorrhage (ICH) is the most serious bleeding complication of vitamin K antagonist (VKA) therapy, carrying a high mortality. Rapid reversal of VKA in ICH is critical. Plasma therapy, the standard of care in the US, is not optimal. The ideal prothrombin complex concentrate (PCC) containing all vitamin K-dependent factors (VKDFs) is not available in the US. Therefore, the authors developed a Trauma Coumadin Protocol (TCP) consisting of a 3-factor PCC available in the US (which contains insufficient factor VII [FVII]) with a low-dose recombinant FVIIa to rapidly reverse VKA. Methods Forty-six patients treated with the TCP were retrospectively analyzed. Fourteen patients had pre- and post-TCP plasma samples collected to assess their VKDF increment. Eleven patients had measurable intraparenchymal hematomas, which were evaluated for expansion. Results The mean pre- and post-TCP international normalized ratios (INRs) were 3.4 (median 2.9) and 1.0 (median 0.9), respectively. Once corrected, INR was maintained at < 1.3 during a patient's hospital stay. The pre-TCP median values of FII, FVII, FIX, and FX were 28%, 21%, 45%, and 20%, respectively; post-TCP median values increased to 144%, 417%, 102%, and 143%, respectively. Four of the 11 patients with measurable intraparenchymal hemorrhage had expansion at 24 hours after TCP. One patient probably (8 hours post-TCP) and 1 patient possibly (3 days post-TCP) had thrombotic complications. Conclusions The TCP was very effective in rapidly reversing VKA-associated coagulopathy; however, this protocol should be used cautiously in patients at high risk for thrombosis. |
| | |
Authors:
|
Ravi Sarode; Karén Matevosyan; Ramesh Bhagat; Cynthia Rutherford; Christopher Madden; Joseph E Beshay |
Related Documents
:
|
10775908 - Revision of staple line failure following roux-en-y gastric bypass for obesity: a follo... 8854438 - Significance of isolated gastric varices among chinese patients. 15329968 - Extremely high body mass index is not a contraindication to laparoscopic gastric bypass. 15810948 - Severe gastritis in the peruvian andes. 1572188 - Right ventricular dysfunction in septic patients. 9282608 - Cervical spine involvement in rheumatoid arthritis: prevalence and relationship with ov... |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2011-12-16 |
Journal Detail:
|
Title: Journal of neurosurgery Volume: - ISSN: 1933-0693 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
|
Created Date: 2011-12-19 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0253357 Medline TA: J Neurosurg Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
|
Departments of Pathology. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The Far-UV Photochemical Bond Cleavage of n-Amyl Nitrite: Bypassing a Repulsive Surface.
Next Document: Clinical, radiological, and pathological features of 24 atypical intracranial epidermoid cysts.