Abstract
Warfarin is commonly used for the prevention and treatment of thromboembolism. However, anticoagulation with warfarin carries an increased risk of intracranial hemorrhage (ICH), which is more often fatal than is spontaneous ICH, although vitamin-K preparation and fresh frozen plasma (FFP) produce significant PT-INR correction within several hours. However, immediate reversal of anticoagulation is achieved with a prothrombin complex concentrate (PCC). We prescribed a PCC for patients with warfarin-associated ICH and examined the effects of PCC. The PCC group comprised 12 patients with warfarin-associated ICH and a PT-INR ≥1.5 at the time of diagnosis, for whom prescription of PCC for correction of anticoagulation was considered. PT-INR was measured on the day of onset of ICH, 10 minutes after the administration of PCC, and on the day following onset. Seven patients with warfarin-associated ICH in whom coagulation was corrected by a vitamin-K preparation and/or FFP before reversal of anticoagulation with PCC was incorporated into our protocol comprised the Control group. The amount of FFP administered within 24 hours of warfarin-associated ICH was 983±818ml in the control group and 193±286ml in the PCC group. In this study, administration of PCC resulted in a significant reduction in the dose of FFP required for correction of coagulability (p<0.05). As indicated by the change in PT-INR following administration of medicine to reverse anticoagulation, treatment with PCC reversed anticoagulation quickly (pretreatment PT-INR: 2.94±1.14 vs 10 minutes after administration: 1.60±0.28). There was no significant difference in 30-day outcomes (Glasgow outcome scale) between the two groups. Although no significant effect on improvement of 30-day outcomes was observed with PCC administration in this study, the PT-INR values were improved quickly and dramatically, which suggests an effect of lowering medical costs associated with the use of FFP. Since the content of coagulation-factors of commercially available PCC varies with brands, a randomized controlled trial would be needed to establish the guideline for the management of warfarin reversal with PCC specific to Japan.
