scholarly journals Combination Therapy Using Prothrombin Complex Concentrate and Vitamin K in Anticoagulated Patients with Traumatic Intracranial Hemorrhage Prevents Progressive Hemorrhagic Injury: A Historically Controlled Study

2020 ◽  
Author(s):  
Hiroshi KOYAMA ◽  
Kenji YAGI ◽  
Keijiro HARA ◽  
Shunji MATSUBARA ◽  
Yoshifumi TAO ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Prothrombin Complex Concentrate ◽  
Controlled Study ◽  
Progressive Hemorrhagic Injury ◽  
Traumatic Intracranial Hemorrhage ◽  
Anticoagulated Patients

Prothrombin complex concentrate for vitamin K antagonist reversal in traumatic intracranial hemorrhage

2020 ◽  
Vol 79 ◽  
pp. 197-202 ◽  
Author(s):  
Christopher Beynon ◽  
Mohammed Nofal ◽  
Timolaos Rizos ◽  
Mona Laible ◽  
Oliver W. Sakowitz ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Prothrombin Complex Concentrate ◽  
Vitamin K Antagonist ◽  
Traumatic Intracranial Hemorrhage

Reversal of warfarin and direct-acting oral anticoagulants in traumatic intracranial hemorrhage: Four factor prothrombin complex concentrates for all?

Trauma ◽  
2020 ◽  
pp. 146040862097050
Author(s):  
Kerry K Moore ◽  
Cassie A Barton ◽  
Elizabeth S Levins ◽  
Heath Oetken ◽  
Elizabeth N Dewey ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Prothrombin Complex Concentrate ◽  
Oral Anticoagulants ◽  
Inclusion Criteria ◽  
Prothrombin Complex Concentrates ◽  
Traumatic Intracranial Hemorrhage ◽  
Baseline Characteristics ◽  
Direct Acting ◽  
Anticoagulated Patients ◽  
Direct Acting Oral Anticoagulants

Background Patients receiving oral anticoagulation who experience a traumatic intracranial hemorrhage (ICH) should receive anticoagulation reversal. Four factor prothrombin complex concentrate (4FPCC) is indicated for reversal of warfarin, and is frequently used for reversal of direct-acting oral anticoagulants (DOACs). The purpose of this study is to compare the safety and efficacy of 4FPCC reversal for traumatic ICH in DOAC- and warfarin-anticoagulated patients. Methods This was a single-center, retrospective review of adult patients with traumatic ICH who received 4FPCC for reversal of anticoagulation between April 2013 and August 2018. The ICH volume on the pre- and post-reversal head CT scans was measured. The primary endpoint was the incidence of expansion of ICH volume of blood using pre-and post-4FPCC imaging. Results A total of 102 patients meeting inclusion criteria were identified with 75 patients in the warfarin group and 27 patients in the DOAC group. There were no significant differences in baseline characteristics between the groups except DOAC patients had larger ICH volumes at baseline as compared to warfarin patients (23.4 mm3 vs 3.7 mm3, p = 0.0001). There was neither a statistical difference in change in ICH volume pre-and post-4FPCC administration, nor in the rate of >20% ICH expansion between the warfarin and DOAC groups. There was no difference in the rate of adverse events compared between groups. Conclusion There was no difference in the either the change in ICH volume or the rate of >20% ICH expansion in patients receiving 4FPCC for reversal DOAC versus warfarin anticoagulation. Rates of complications were low in both groups.

scholarly journals Fixed Versus Variable Dosing of Prothrombin Complex Concentrate in Vitamin K Antagonist-Related Intracranial Hemorrhage: A Retrospective Analysis

2016 ◽  
Vol 26 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Rahat Amadkhan Abdoellakhan ◽  
Ishita Parveen Miah ◽  
Nakisa Khorsand ◽  
Karina Meijer ◽  
Korné Jellema
Keyword(s):  
Retrospective Analysis ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Prothrombin Complex Concentrate ◽  
Vitamin K Antagonist

Prothrombin Complex Concentrate Accelerates International Normalized Ratio Reversal and Diminishes the Extension of Intracranial Hemorrhage in Geriatric Trauma Patients

2014 ◽  
Vol 80 (4) ◽  
pp. 372-376 ◽  
Author(s):  
Mathew Edavettal ◽  
Amelia Rogers ◽  
Frederick Rogers ◽  
Michael Horst ◽  
Wichitah Leng
Keyword(s):  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Prothrombin Complex Concentrate ◽  
Ideal Body Weight ◽  
International Normalized Ratio ◽  
Geriatric Trauma ◽  
Control Group ◽  
Trauma Patients ◽  
Geriatric Population ◽  
Rapid Reversal

Warfarin therapy increases the incidence intracranial hemorrhage (ICH), especially in the geriatric population. Timely reversal of international normalized ratio (INR) is integral in the management of these patients for whom fresh frozen plasma (FFP) with vitamin K is the standard of treatment. We hypothesized that implementing a protocol that used prothrombin complex concentrate (PCC) would reverse INR values more swiftly and decrease the amount of FFP administered. In November 2011, a protocol was implemented for administering PCC to the geriatric population on warfarin admitted for life-threatening bleeds. These patients received 25 IU/kg ideal body weight of a three-factor PCC (Profilnine SD) if their INR was over 1.5 or greater. FFP was given if follow-up INR revealed an INR of 1.5 or greater. Retrospectively the data from 29 patients who received PCC were compared with a historical control group of 34 patients. Protocol use resulted in a significantly faster INR reversal (PCC: 151.6 ± 84.3 minutes vs control: 485.0 ± 321 minutes; P < 0.001), time to achieve an INR less than 1.5 (PCC: 484 ± 242 minutes vs control: 971 ± 1208 minutes; P = 0.036), and less FFP administered (PCC: 1.3 ± 1.0 vs control:3.3 ± 1.5; P < 0.001). PCC patients had a decreased incidence of progression of their ICH (PCC: 17.2% vs control: 44.2%; P = 0.031). Rapid reversal of coagulopathy in geriatric patients on warfarin is vital to limit the extent of ICH. PCC allows a much more rapid reversal than standard treatment with only FFP and vitamin K. Adopting such a protocol is associated not only with a more rapid reversal and less FFP use, but also less patients went on to extend their head bleeds.

Newer and Better? Comparing Direct Oral Anticoagulants to Warfarin in Patients With Traumatic Intracranial Hemorrhage

2020 ◽  
Vol 86 (9) ◽  
pp. 1062-1066
Author(s):  
Joshua D. Billings ◽  
Abid D. Khan ◽  
John H. McVicker ◽  
Thomas J. Schroeppel
Keyword(s):  
Intracranial Hemorrhage ◽  
Injury Severity ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Outcome Data ◽  
Trauma Patients ◽  
Reversal Agents ◽  
Traumatic Intracranial Hemorrhage ◽  
Anticoagulated Patients

Background Direct oral anticoagulants (DOACs) have overtaken warfarin as the preferred anticoagulants for stroke prevention with atrial fibrillation and for treatment of venous thromboembolism. Despite the increased prevalence of DOACs, literature studying their impact on trauma patients with intracranial hemorrhage (ICH) remains limited. Most DOAC reversal agents have only been recently available, and concerns for worse outcomes with DOACs among this population remain. This study aims to assess the outcomes of patients with traumatic ICH taking DOACs compared with those taking warfarin. Methods A retrospective analysis of patients with traumatic ICH over a 5-year period was conducted. Demographics, injury severity, medication, and outcome data were collected for each patient. Patients taking warfarin and DOACs were compared. Results 736 patients had traumatic ICH over the study period, 75 of which were on either DOACs (25 patients) or warfarin (50 patients). The median age of the anticoagulated patients was 78 years; 52% were female, and 91% presented secondary to a fall. DOACs were reversed at close to half the rate of warfarin (40% vs 77%; P = .032). Despite this, the 2 groups had similar rates of worsening examination, need for operative intervention, and in-hospital mortality. In the follow-up, fewer patients taking DOACs had died at 6-months postinjury compared with those taking warfarin (8% vs 30%; P = .041). Discussion Despite DOACs being reversed at nearly half the rate of warfarin, patients presenting with traumatic ICH on warfarin had higher 6-month mortality suggesting a potential survival advantage for DOACs over warfarin in this population.

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