Abstract | BACKGROUND: METHODS: A prospective, observational study was conducted of patients who received PCC (Bebulin VH), FFP, or PCC + FFP. All groups received vitamin K 10 mg IV. INR reversal (<1.4), adverse events ( venous thromboembolism, myocardial infraction, pulmonary edema), major hemorrhage (new or worsened intracranial hemorrhage, anemia requiring transfusion or GI bleed), and 3-month functional outcome were compared between the groups using Chi squared and logistic regression analysis. RESULTS: Of 64 patients, PCC alone was used in 16 (mean dose 48 IU/kg), FFP alone in 25 (mean dose 12.5 ml/kg), and PCC + FFP in 23 (median doses 47.4 IU/kg and 11.4 ml/kg, respectively). INR correction occurred in 88, 84, and 70 %, respectively. There were no differences in time to INR correction or adverse events between the groups, but FFP alone was associated with more major hemorrhage after administration (52 %, OR 5.0, 95 % CI 1.6-15.4, P = 0.006) and PCC with less (6 %, OR 0.1, 95 % CI 0.01-0.8, P = 0.033). After adjusting for age, admission GCS, initial INR, and bleed type, the use of PCC was associated with a lower risk of death or severe disability at 3-months (adjusted OR 0.02, 95 % CI 0.001-0.8, P = 0.039), while FFP alone was associated with a higher risk (adjusted OR 51.6, 95 % CI 1.2-2163.1, P = 0.039). CONCLUSIONS: PCC adequately corrected INR without any increase in adverse events compared to FFP and was associated with less major hemorrhage and improved 3-month outcomes in patients with warfarin-associated intracranial hemorrhage.
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Authors | Jennifer A Frontera, Errol Gordon, Victor Zach, Maximo Jovine, Ken Uchino, Muhammad S Hussain, Louis Aledort |
Journal | Neurocritical care
(Neurocrit Care)
Vol. 21
Issue 3
Pg. 397-406
(Dec 2014)
ISSN: 1556-0961 [Electronic] United States |
PMID | 24671832
(Publication Type: Comparative Study, Journal Article, Observational Study)
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Chemical References |
- Anticoagulants
- Antifibrinolytic Agents
- Blood Coagulation Factors
- Vitamin K
- prothrombin complex concentrates
- Warfarin
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Anticoagulants
(adverse effects)
- Antifibrinolytic Agents
(therapeutic use)
- Blood Coagulation Disorders
(chemically induced, complications, therapy)
- Blood Coagulation Factors
(therapeutic use)
- Blood Component Transfusion
(methods)
- Female
- Hemorrhage
(chemically induced)
- Humans
- International Normalized Ratio
- Intracranial Hemorrhages
(chemically induced, etiology)
- Logistic Models
- Male
- Middle Aged
- Plasma
- Prospective Studies
- Treatment Outcome
- Vitamin K
(therapeutic use)
- Warfarin
(adverse effects)
- Young Adult
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