Use of Factor IX Complex in Warfarin-related Intracranial Hemorrhage

Use of Factor IX Complex in Warfarin-related Intracranial Hemorrhage AbstractOBJECTIVE:Anticoagulation-treated patients presenting with intracranial hemorrhage, including subdural hematoma, epidural hematoma, subarachnoid hemorrhage, and intracerebral hemorrhage, require urgent correction of their coagulopathy to prevent worsening hemorrhage and to facilitate surgical intervention when necessary. In this study, we compared the use of fresh frozen plasma (FFP) with that of Factor IX complex concentrate (FIXCC) to achieve rapid correction of warfarin anticoagulationMETHODS:Patients admitted to a tertiary care center with computed tomography-proven intracranial hemorrhage and a prothrombin time of more than 17 seconds were considered for inclusion in the study protocol. Complete data sets were obtained for eight patients randomized to treatment with FFP and five patients randomized to treatment with FFP supplemented with FIXCC. The prothrombin time and International Normalized Ratio were measured every 2 hours for 14 hours. Correction of anticoagulation was defined as an International Normalized Ratio of ≤1.3.RESULTS:A difference in repeated International Normalized Ratio measurements during the first 6 hours of correction was observed between the FIXCC and FFP groups (P <0.03). The rate of correction was greater (P <0.01) and the time to correction was shorter (P <0.01) for the FIXCC-treated group. No difference in neurological outcomes was detected between groups, but a higher complication rate was observed for the FFP-treated group.CONCLUSION:The use of FIXCC accelerated correction of warfarin-related anticoagulation in the presence of intracranial hemorrhage. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Use of Factor IX Complex in Warfarin-related Intracranial Hemorrhage

Use of Factor IX Complex in Warfarin-related Intracranial Hemorrhage

Use of Factor IX Complex in Warfarin-related Intracranial Hemorrhage Nicholas M. Boulis, M.D., Miroslav P. Bobek, M.D., Alvin Schmaier, M.D., Julian T. Hoff, M.D. S e c t i o n o f N e u r o s u r g e r y , D e p a r t m e n t o f S u r g e r y ( N M B , M PB , JTH), a n d S e c t i o n o f H e m a t o l o g y , D e p a r t m e n t s of I n t e r n a l M e d i c i n e a n d P a t h o l o g y (AS), U n i v e r s i t y o f M i c h i g a n , A n n A r b o r , M i c h i g a n OBJECTIVE: Anticoagulation-treated patients presenting with intracranial hemorrhage, including subdural hema­ toma, epidural hematoma, subarachnoid hemorrhage, and intracerebral hemorrhage, require urgent correction of their coagulopathy to prevent worsening hemorrhage and to facilitate surgical intervention when necessary. In this study, we compared the use of fresh frozen plasma (FFP) with that of Factor IX complex concentrate (FIXCC) to achieve rapid correction of warfarin anticoagulation. METFIODS: Patients admitted to a tertiary care center with computed tomography-proven intracranial hemorrhage and a prothrombin time of more than 17 seconds were considered for inclusion in the study protocol. Complete data sets were obtained for eight patients randomized to treatment with FFP and five patients randomized to treatment with FFP supplemented with FIXCC. The prothrombin time and International Normalized Ratio were measured every 2 hours for 14 hours. Correction of anticoagulation was defined as an International Normalized Ratio of ^1.3. RESULTS: A difference in repeated International Normalized Ratio measurements during the first 6 hours of correction was observed between the FIXCC and FFP groups ( P < 0.03). The rate of correction was greater (P < 0.01) and the time to correction was shorter (P < 0.01) for the FIXCC-treated group. No difference in neurological outcomes was detected between groups, but a higher complication rate was observed for the FFP-treated group. CO N CLUSIO...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199911000-00020
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:Anticoagulation-treated patients presenting with intracranial hemorrhage, including subdural hematoma, epidural hematoma, subarachnoid hemorrhage, and intracerebral hemorrhage, require urgent correction of their coagulopathy to prevent worsening hemorrhage and to facilitate surgical intervention when necessary. In this study, we compared the use of fresh frozen plasma (FFP) with that of Factor IX complex concentrate (FIXCC) to achieve rapid correction of warfarin anticoagulationMETHODS:Patients admitted to a tertiary care center with computed tomography-proven intracranial hemorrhage and a prothrombin time of more than 17 seconds were considered for inclusion in the study protocol. Complete data sets were obtained for eight patients randomized to treatment with FFP and five patients randomized to treatment with FFP supplemented with FIXCC. The prothrombin time and International Normalized Ratio were measured every 2 hours for 14 hours. Correction of anticoagulation was defined as an International Normalized Ratio of ≤1.3.RESULTS:A difference in repeated International Normalized Ratio measurements during the first 6 hours of correction was observed between the FIXCC and FFP groups (P <0.03). The rate of correction was greater (P <0.01) and the time to correction was shorter (P <0.01) for the FIXCC-treated group. No difference in neurological outcomes was detected between groups, but a higher complication rate was observed for the FFP-treated group.CONCLUSION:The use of FIXCC accelerated correction of warfarin-related anticoagulation in the presence of intracranial hemorrhage.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1999

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