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Rapid warfarin reversal in the setting of intracranial hemorrhage: a comparison of plasma, recombinant activated Factor VII, and prothrombin complex concentrate.
MedLine Citation:
PMID:  23220122     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: - This study compares the safety and effectiveness of three methods of reversing coagulopathic effects of warfarin in patients with potentially life-threatening intracranial hemorrhage. METHODS: - A retrospective electronic medical record (EMR) review of 63 patients with warfarin-related intracranial hemorrhage between 2007 and 2010 in an integrated healthcare delivery system was conducted. The three methods of rapid warfarin reversal were fresh frozen plasma (FFP), activated factor VII (FVIIa, NovoSeven(®)RT), and prothrombin complex concentrate (PCC, Bebulin(®)VH, Profilnine(®)SD), each used adjunctively with vitamin K (Vit K, phytonadione). We determined times from reversal agent order to laboratory evidence of warfarin reversal (international normalized ratio [INR]) in the first 48 hours, and compared INR rebound rates and complications in the first 48 hours. RESULTS: Reversal with FFP took more than twice as long compared to FVIIa or PCC. To reach an INR of 1.3, mean (+SD) reversal times were 1933 + 905 minutes for FFP, 784 + 926 minutes for FVIIa, and 980 + 1021 minutes for PCC (P<0.001; P<0.01 between FFP and FVIIa, P<0.05 between FFP and PCC). INR rebound occurred in 0/31 patients for FFP, 4/8 for FVIIa, and 0/7 for PCC (P = 0.001). Complications were uncommon. FVIIa was 15 and 3.5 times as expensive as FFP and PCC, respectively. CONCLUSION: In adjunct to Vit K for rapid warfarin reversal, FVIIa and PCC appear more effective than FFP. Either FVIIa or PCC are reasonable options for reversal, but FVIIa is considerably more expensive and may have greater risk of INR rebound.
Authors:
Carolyn H Woo; Nihar Patel; Carol Conell; Vivek A Rao; Bonnie S Faigeles; Minal C Patel; Jasmeen Pombra; Paul T Akins; Yekaterina K Axelrod; Ivy Y Ge; William F Sheridan; Alexander C Flint
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-5
Journal Detail:
Title:  World neurosurgery     Volume:  -     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Department of Pharmacy, Kaiser Permanente Medical Center, San Francisco, USA. Electronic address: Carolyn.H.Woo@kp.org.
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