Treatments for Reversing Warfarin Anticoagulation in Patients with Acute Intracranial Hemorrhage
Author Information
Author(s): Bechtel Brett F, Nunez Timothy C, Lyon Jennifer A, Cotton Bryan A, Barrett Tyler W
Primary Institution: Vanderbilt University Medical Center
Hypothesis
What are the advantages and risks of the available treatment options for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage?
Conclusion
There is no uniform standard for reversing warfarin in intracranial hemorrhage, but intravenous vitamin K along with fresh frozen plasma or prothrombin complex concentrate is recommended.
Supporting Evidence
- Warfarin increases the risk and severity of intracranial hemorrhage.
- Prothrombin complex concentrate is faster at correcting INR compared to fresh frozen plasma.
- Recombinant factor VIIa can rapidly reverse warfarin's effect on INR but is not FDA-approved.
Takeaway
Doctors need to know how to quickly reverse the effects of warfarin in patients with brain bleeding, and there are different treatments available.
Methodology
A structured literature search and review of articles relevant to intracranial hemorrhage and warfarin was performed, resulting in 23 original studies for inclusion.
Potential Biases
Variation in federal regulatory drug agency approvals impacts reporting as PCC is approved in most nations but not in the US.
Limitations
The available literature consists primarily of small case series and retrospective cohort studies, limiting the strength of findings.
Participant Demographics
Patients on warfarin with spontaneous or traumatic intracranial hemorrhage.
Statistical Information
P-Value
p<0.05
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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