Treatment of Warfarin-related intracranial hemorrhage

A comparison of prothrombin complex concentrate and recombinant activated factor VII

Nathan A. Pinner, April C. Hurdle, Carrie Oliphant, Anne Reaves, Bob Lobo, Allen Sills

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

Objective: Warfarin-related intracranial hemorrhage (ICH) is a devastating complication of warfarin therapy. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH. Methods We retrospectively reviewed the charts of 15 patients who received rFVIIa and 9 who received PCC for treatment of warfarin-related ICH over a 2-year period. The primary objective was to compare the efficacy of rFVIIa and PCC in correcting the INR to 1.3 or less. Baseline INR was compared to INR obtained within 1, 3, 6, 12, and 24 hours after rFVIIa or PCC administration. Results Six patients in the rFVIIa group and five in the PCC group had a follow-up INR within 1 hour of agent administration. In the rFVIIa group, the mean INR decreased from 6.1 to 1.1 and from 2.3 to 1.48 in the PCC group. At 6 hours, all rFVIIa patients and six (67%) PCC patients had at least one subsequent INR, with 93% and 50% correcting to an INR of 1.3 or less. Mean dose for all patients included was 53.4 ± 17.5 μg/kg and 27.8 ± 15.4 units/kg for rFVIIa and PCC, respectively. Conclusion Correction of the INR is more reliably obtained with rFVIIa when compared to PCC. Larger, prospective studies comparing these therapies for warfarin-related ICH are needed.

Original languageEnglish (US)
Pages (from-to)631-635
Number of pages5
JournalWorld Neurosurgery
Volume74
Issue number6
DOIs
StatePublished - Dec 1 2010

Fingerprint

Factor VIIa
International Normalized Ratio
Intracranial Hemorrhages
Warfarin
Therapeutics
prothrombin complex concentrates
recombinant FVIIa
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Treatment of Warfarin-related intracranial hemorrhage : A comparison of prothrombin complex concentrate and recombinant activated factor VII. / Pinner, Nathan A.; Hurdle, April C.; Oliphant, Carrie; Reaves, Anne; Lobo, Bob; Sills, Allen.

In: World Neurosurgery, Vol. 74, No. 6, 01.12.2010, p. 631-635.

Research output: Contribution to journalReview article

Pinner, Nathan A. ; Hurdle, April C. ; Oliphant, Carrie ; Reaves, Anne ; Lobo, Bob ; Sills, Allen. / Treatment of Warfarin-related intracranial hemorrhage : A comparison of prothrombin complex concentrate and recombinant activated factor VII. In: World Neurosurgery. 2010 ; Vol. 74, No. 6. pp. 631-635.
@article{b96ce6c3a55a4662972326690065aa88,
title = "Treatment of Warfarin-related intracranial hemorrhage: A comparison of prothrombin complex concentrate and recombinant activated factor VII",
abstract = "Objective: Warfarin-related intracranial hemorrhage (ICH) is a devastating complication of warfarin therapy. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH. Methods We retrospectively reviewed the charts of 15 patients who received rFVIIa and 9 who received PCC for treatment of warfarin-related ICH over a 2-year period. The primary objective was to compare the efficacy of rFVIIa and PCC in correcting the INR to 1.3 or less. Baseline INR was compared to INR obtained within 1, 3, 6, 12, and 24 hours after rFVIIa or PCC administration. Results Six patients in the rFVIIa group and five in the PCC group had a follow-up INR within 1 hour of agent administration. In the rFVIIa group, the mean INR decreased from 6.1 to 1.1 and from 2.3 to 1.48 in the PCC group. At 6 hours, all rFVIIa patients and six (67{\%}) PCC patients had at least one subsequent INR, with 93{\%} and 50{\%} correcting to an INR of 1.3 or less. Mean dose for all patients included was 53.4 ± 17.5 μg/kg and 27.8 ± 15.4 units/kg for rFVIIa and PCC, respectively. Conclusion Correction of the INR is more reliably obtained with rFVIIa when compared to PCC. Larger, prospective studies comparing these therapies for warfarin-related ICH are needed.",
author = "Pinner, {Nathan A.} and Hurdle, {April C.} and Carrie Oliphant and Anne Reaves and Bob Lobo and Allen Sills",
year = "2010",
month = "12",
day = "1",
doi = "10.1016/j.wneu.2010.06.030",
language = "English (US)",
volume = "74",
pages = "631--635",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Treatment of Warfarin-related intracranial hemorrhage

T2 - A comparison of prothrombin complex concentrate and recombinant activated factor VII

AU - Pinner, Nathan A.

AU - Hurdle, April C.

AU - Oliphant, Carrie

AU - Reaves, Anne

AU - Lobo, Bob

AU - Sills, Allen

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Objective: Warfarin-related intracranial hemorrhage (ICH) is a devastating complication of warfarin therapy. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH. Methods We retrospectively reviewed the charts of 15 patients who received rFVIIa and 9 who received PCC for treatment of warfarin-related ICH over a 2-year period. The primary objective was to compare the efficacy of rFVIIa and PCC in correcting the INR to 1.3 or less. Baseline INR was compared to INR obtained within 1, 3, 6, 12, and 24 hours after rFVIIa or PCC administration. Results Six patients in the rFVIIa group and five in the PCC group had a follow-up INR within 1 hour of agent administration. In the rFVIIa group, the mean INR decreased from 6.1 to 1.1 and from 2.3 to 1.48 in the PCC group. At 6 hours, all rFVIIa patients and six (67%) PCC patients had at least one subsequent INR, with 93% and 50% correcting to an INR of 1.3 or less. Mean dose for all patients included was 53.4 ± 17.5 μg/kg and 27.8 ± 15.4 units/kg for rFVIIa and PCC, respectively. Conclusion Correction of the INR is more reliably obtained with rFVIIa when compared to PCC. Larger, prospective studies comparing these therapies for warfarin-related ICH are needed.

AB - Objective: Warfarin-related intracranial hemorrhage (ICH) is a devastating complication of warfarin therapy. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH. Methods We retrospectively reviewed the charts of 15 patients who received rFVIIa and 9 who received PCC for treatment of warfarin-related ICH over a 2-year period. The primary objective was to compare the efficacy of rFVIIa and PCC in correcting the INR to 1.3 or less. Baseline INR was compared to INR obtained within 1, 3, 6, 12, and 24 hours after rFVIIa or PCC administration. Results Six patients in the rFVIIa group and five in the PCC group had a follow-up INR within 1 hour of agent administration. In the rFVIIa group, the mean INR decreased from 6.1 to 1.1 and from 2.3 to 1.48 in the PCC group. At 6 hours, all rFVIIa patients and six (67%) PCC patients had at least one subsequent INR, with 93% and 50% correcting to an INR of 1.3 or less. Mean dose for all patients included was 53.4 ± 17.5 μg/kg and 27.8 ± 15.4 units/kg for rFVIIa and PCC, respectively. Conclusion Correction of the INR is more reliably obtained with rFVIIa when compared to PCC. Larger, prospective studies comparing these therapies for warfarin-related ICH are needed.

UR - http://www.scopus.com/inward/record.url?scp=79951573799&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79951573799&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2010.06.030

DO - 10.1016/j.wneu.2010.06.030

M3 - Review article

VL - 74

SP - 631

EP - 635

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 6

ER -