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Use of Prothrombin Complex Concentrate for Vitamin K Antagonist Reversal before Surgical Treatment of Intracranial Hemorrhage.
MedLine Citation:
PMID:  21769259     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Oral anticoagulant therapy (OAT) is used to prevent/treat thromboembolism. Major bleeding is common in patients on OAT; eg, warfarin increases intracranial hemorrhage (ICH) risk.
CASE: A 71-year-old male on warfarin (to reduce stroke risk) presented at Accident and Emergency Minor Injuries Unit with headache after reportedly sounding 'drunk'. On triage, the patient appeared lucid and well. However, International Normalized Ratio (INR) was 4.1. Head computed tomography (CT) indicated a large right-sided subdural hematoma. Prothrombin complex concentrate (PCC; Beriplex(®) P/N, CSL Behring) with vitamin K normalized the INR within minutes of administration. The patient underwent neurosurgery without complications, and was discharged after 5 days, with no residual neurological symptoms.
CONCLUSIONS: ICH patients can present with no neurological signs. In OAT patients with headache, INR must be established; if ≥3.0, normalization of INR and head CT are essential. PCC is the best option to rapidly reverse anticoagulation and correct INR pre-surgery.
Authors:
Yun Wong
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Publication Detail:
Type:  Journal Article     Date:  2011-01-12
Journal Detail:
Title:  Clinical medicine insights. Case reports     Volume:  4     ISSN:  1179-5476     ISO Abbreviation:  Clin Med Insights Case Rep     Publication Date:  2011  
Date Detail:
Created Date:  2011-07-19     Completed Date:  2011-11-10     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101531893     Medline TA:  Clin Med Insights Case Rep     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  1-6     Citation Subset:  -    
Affiliation:
Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ, UK.
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