Журнал тромбоза и кровообращения: открытый доступ

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An Analysis of Outcomes after Administration of Four Factor Prothrombin Complex Concentrate for Urgent Reversal of Anticoagulation in Patients with Intracranial Hemorrhage

Painter MD, Farrell MS, Wiedner MC, Perza M, Caplan RJ and Cipolle MD

Introduction: Four factor prothrombin complex concentrate (PCC4) and vitamin K are used for urgent reversal of coagulopathy in patients with intracranial hemorrhage while on vitamin K antagonists (VKA) and factor Xa inhibitors. Evaluation in a ‘real world’ population has not been performed.

Material and methods: Retrospective review of 110 patients with hemorrhagic stroke (n=75) or traumatic ICH (n= 35) at a comprehensive stroke and trauma center, from 9/2013 and 12/2016. PCC4 was used to reverse coagulopathy in VKA-related ICH in 75 patients and for factor Xa inhibitors in 35 patients.

Results: Between patient groups taking VKA and factor Xa inhibitors, there was no difference in Glasgow Coma Scale (GCS), or Marshall and Rotterdam CT scores. No differences were noted between VKA and factor Xa inhibitor-related ICH in median size of ICH on initial (p=0.69) or repeat (p=0.35) imaging. No difference was noted in ICH size progression (p=0.99). Rates of thromboembolic complications were noted in 13.3% of patients taking VKAs, higher than that reported in the literature. This relative hypercoagulable response was not noted in patients taking factor Xa inhibitors, as 0% suffered a thromboembolic event.

Conclusion: Despite arrest of ICH progression in most patients, the high rate of thromboembolic events in the VKA population suggests the risk of adverse events in a “real world” population is not insignificant and must be considered with respect to the clinical picture. Further studies are necessary to determine which patients are ideally suited to undergo repletion with PCC4 using expanded criteria.