Recombinant Factor VIIa for Rapid Reversal of Warfarin Anticoagulation in Acute Intracranial Hemorrhage

Freeman, William D.; Brott, Thomas G.; Barrett, Kevin M.; Castillo, Pablo R.; Deen, H. Gordon; Czervionke, Leo F.; Meschia, James F.

doi:10.4065/79.12.1495

Cited by 186 publications

(114 citation statements)

References 22 publications

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“…This improved survival was not at the cost of survival of very disabled patients. 20,21 Not only was Hanger et al disability in those surviving found to be no worse, but there were greater functional gains with PCC. There was also a trend suggesting that earlier treatment with PCC is better than late, but late still seemed better than none at all.…”

Section: Discussionmentioning

confidence: 99%

“…While our CT scan to reversal times were longer than we desired, they are similar to other studies. [21][22][23][24][25] Had these delays been shortened, the effect of PCC may have been greater. High mortality rates with WRICH and some incomplete data collection contributed to smaller numbers of patients available for functional outcomes analysis.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24][25] Earlier treatment appears better. Vitamin K is readily available, yet was not given immediately following CT confirmation.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Warfarin‐related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates

Hanger

Geddes

Wilkinson

et al. 2013

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Warfarin‐related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates

Hanger

Geddes

Wilkinson

et al. 2013

Internal Medicine Journal

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“…50 It was initially used for the treatment of inhibitors in patients with hemophilia. It has also been used in the past to correct anticoagulation in patients with acute ICH, 36 but most studies have been done in patients with hemophilia or factor VII deficiency. 50 Major limitations include cost, prothrombotic potential, and lack of correction of other coagulation factors dependent on vitamin K. Studies have shown that factor VII may be a safe, rapid, and effective way of reversing anticoagulation and may offer an improved quality of life to patients with ICH.…”

Section: Fresh Frozen Plasma (Ffp)mentioning

confidence: 99%

“…36,37 Given the multiple interactions of warfarin with other medications, this is a significant concern because ICH is associated with substantial neurological deterioration. 38 Although most warfarin-induced ICH occurs in patients with therapeutic INR, it becomes the most prevalent mechanism when the INR exceeds 5.0, and it should be highly suspected.…”

Section: Hemorrhagic Stroke/ich Introductionmentioning

confidence: 99%

Approach to and management of the acute stroke patient with atrial fibrillation: A literature review

Marmagkiolis

Nikolaidis

Politis

et al. 2008

Journal of Hospital Medicine

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Stroke remains an increasing worldwide cause of disability and mortality, and it is the second leading cause of death in industrialized countries. 1 Patients with atrial fibrillation form a unique group with increased risk of cardioembolic stroke.Despite the widespread application of the National Institutes of Health stroke scale and guidelines, 2,3 patients with atrial fibrillation represent a clinically challenging group that deserves a special approach during the acute stroke phase.The mechanism of stroke in these patients is either cardioembolic [especially with an international normalized ratio (

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Symptomatic Intracerebral Hemorrhage in Acute Ischemic Stroke After Thrombolysis With Intravenous Recombinant Tissue Plasminogen Activator

2014

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IMPORTANCE-Intravenous thrombolysis remains the mainstay treatment for acute ischemic stroke. One of the most feared complications of the treatment is thrombolysis-related symptomatic intracerebral hemorrhage (sICH), which occurs in nearly 6% of patients and carries close to 50% mortality. The treatment options for sICH are based on small case series and expert opinion, and the efficacy of recommended treatments is not well known.OBJECTIVE-To provide an overview on the rationale and mechanism of action of potential treatments for sICH that may reverse the coagulopathy before hematoma expansion occurs. EVIDENCE REVIEW-Evidence-based peer-reviewed articles, including randomized trials, case series and reports, and retrospective reviews, were identified in a PubMed search on the mechanism of action of intravenous recombinant tissue plasminogen activator and the rationale of various potential treatments using the coagulation cascade as a model. The search encompassed articles published from January 1, 1990, through February 28, 2014.FINDINGS-The current treatments may not be sufficient to reverse coagulopathy early enough to prevent hematoma expansion and improve the outcome of thrombolysis-related hemorrhage.CONCLUSIONS AND RELEVANCE-Given the mechanism of action of intravenous recombinant tissue plasminogen activator, clinical studies could include agents with a fast onset of action, such as prothrombin complex concentrate, recombinant factor VIIa, and ε-aminocaproic acid, as potential therapeutic options.

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Recombinant Factor VIIa for Rapid Reversal of Warfarin Anticoagulation in Acute Intracranial Hemorrhage

Cited by 186 publications

References 22 publications

Warfarin‐related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates

Warfarin‐related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates

Approach to and management of the acute stroke patient with atrial fibrillation: A literature review

Symptomatic Intracerebral Hemorrhage in Acute Ischemic Stroke After Thrombolysis With Intravenous Recombinant Tissue Plasminogen Activator

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