Anticoagulation Reversal with Prothrombin Complex Concentrate in Aneurysmal Subarachnoid Hemorrhage

Beynon, Christopher; Nofal, Mohammed; Rizos, Timolaos; Laible, Mona; Potzy, Anna; Unterberg, Andreas; Sakowitz, Oliver W.

doi:10.1016/j.jemermed.2015.05.032

Cited by 12 publications

(5 citation statements)

References 23 publications

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“…Nevertheless, the mortality rate was high, and outcomes were poor, in patients with warfarin-associated coagulopathy, and were mainly attributed to greater disease severity. Our findings contribute to the growing literature showing that the PCC facilitates neurosurgical intervention in patients taking VKAs and requiring urgent neurosurgical intervention, and is associated with acceptable safety and efficacy [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

Section: Discussionsupporting

confidence: 62%

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

et al. 2018

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Objective: The number of patients presenting with warfarin-associated intracranial bleeding and needing neurosurgical intervention is growing. Prothrombin complex concentrate (PCC) is commonly used for anti-coagulation reversal before emergent surgery. We present our experience with PCC use in patients presenting with coagulopathy and needing urgent craniotomy. Methods: We retrospectively identified all patients presenting with intracranial bleeding and coagulopathy due to warfarin use, requiring urgent neurosurgical procedures, from January, 2014 (implementation of 4-PCC therapy) until December, 2016. For coagulation reversal, all patients received 4-PCC (Octaplex) and vitamin K. Results: Thirty-five consecutive patients (17 men; median age 72 years) were administered 4-PCC before emergent neurosurgical procedures. The majority of patients presented with traumatic subdural hematoma (62%) and spontaneous intracerebral hemorrhage (32%). All patients were taking warfarin. Median international normalized ratio (INR) on admission was 2.94 (range: 1.20 to 8.60). Median 4-PCC dose was 2000 I.U. (range: 500 I.U. to 3000 I.U.). There was a statically significant decrease in INR (p < 0.01), PT (p < 0.01), and PTT (p = 0.02) after 4-PCC administration. Postoperative INR values were ≤3.00 in all patients, and seven (20%) patients had normal INR values. There were no 4-PCC related complications. Four (11%) patients developed subdural/epidural hematoma and 20 (57%) patients died. Mortality was associated with lower Glasgow coma scale (GCS) score. Conclusions: The 4-PCC facilitates INR reversal and surgery in patients presenting with warfarin-associated coagulopathy and intracranial bleeding requiring urgent neurosurgical intervention.

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Section: Discussionsupporting

confidence: 62%

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

et al. 2018

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“…In the future, 4F-PCC and neutralizers of DOACs will be used for patients with preceding warfarin or DOACs. 17 )…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation, Treatment, and Outcome of Nontraumatic Subarachnoid Hemorrhage in Patients with Preceding Antithrombotic Therapy

Uno

Yagi

Takai

et al. 2023

Neurol. Med. Chir.(Tokyo)

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With the aging of the population, the number of people taking antithrombotic drugs is increasing. Few reports have described the clinical presentation, treatment, and outcomes of nontraumatic subarachnoid hemorrhage (SAH) in patients with preceding antithrombotic therapy. This study included 459 patients with nontraumatic SAH who had been treated between April 2009 and May 2021. Overall, 39 of the 459 patients with aneurysmal SAH were on antithrombotic therapy before ictus (8.5%). Therefore, we classified patients into two groups: Group A (n = 39), patients with preceding antithrombotic therapy and Group B (n = 420), patients without preceding antithrombotic therapy. Hunt and Kosnik (H&K) grade on admission was significantly higher in Group A than in Group B (p = 0.02). Patients in Group A more frequently received endovascular treatment. The rate of endovascular therapy for symptomatic vasospasm after SAH was significantly lower in Group A (2.6%) than in Group B (15.5%; p = 0.03). The outcomes at 3 months after onset were significantly poorer in Group A patients than in Group B patients (p = 0.03). Patients with preceding antithrombotic drugs tended to be at greater risk of unfavorable outcomes, but this difference was not significant in the univariate analysis. In the multivariate analysis, patient age, H&K grade ! 4, and subdural hematoma remained as risk factors for poor outcomes; however, preceding use of antithrombotic drugs was not a significant risk factor.

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“…38 Under-triage, or taking a patient to a lower-level of care than optimal, introduces delays due to secondary transfer. Emergent definitive neurosurgical care with ventriculostomy, decompressive craniectomy, or aneurysmal clipping or coiling for ICH 39,40 and SAH [41][42][43][44] is unnecessarily delayed. Overtriage, or taking a patient to a higher level of care than required, can overwhelm highlyspecialized centers and impact the ability to accept higher-acuity transfers due to capacity, can starve less-specialized centers of case volume and clinical experience, and can delay care for patients who do not need the advanced therapies offered at the specialty center (e.g., prolonged time IV tPA).…”

Section: Discussion Panel Chris Lewandowski Wade Smith Nerses Sanossian Martin Ebingermentioning

confidence: 99%

14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy: Proceedings and summary of discussions

Sheth

Lopez‐Rivera

Lee

et al. 2019

International Journal of Stroke

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The 14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy (TTST) took place in Houston, Texas on 21-22 October 2018. Attended by 150þ invited global experts, the objectives of TTST 2018 were to explore the changing landscape of acute ischemic stroke therapy and to address current controversies in thrombolysis and thrombectomy, including expanding access and systems of care with global relevance. This article summarizes the proceedings of TTST 2018. The key points of each session are listed below, the full text of presentations and discussion are

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Anticoagulation Reversal with Prothrombin Complex Concentrate in Aneurysmal Subarachnoid Hemorrhage

Cited by 12 publications

References 23 publications

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

Clinical Presentation, Treatment, and Outcome of Nontraumatic Subarachnoid Hemorrhage in Patients with Preceding Antithrombotic Therapy

14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy: Proceedings and summary of discussions

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