Prothrombin complex concentrates for oral anticoagulant therapy-related intracranial hemorrhage: A review of the literature

Eric M. Bershad, Jose Suarez

Research output: Contribution to journalReview article

Abstract

Warfarin-related intracranial hemorrhage carries a high mortality and poor neurological outcome. Rapid reversal of coagulopathy is a cornerstone of medical therapy to halt bleeding progression; however the optimal approach remains undefined. Prothrombin complex concentrates have promising features that may rapidly reverse coagulopathy, but remain relatively unstudied. We aim to review the literature regarding the use of prothrombin complex concentrates in patients with warfarin-related intracranial hemorrhage. A comprehensive review of the literature was conducted using PUBMED and Google Scholar databases to identify the use of PCC in patients with warfarin-related intracranial hemorrhage. The characteristics abstracted included the type of PCC, dosing, study design, type of intracranial hemorrhage, changes in the INR, and adverse effects. Prothrombin complex concentrates are heterogenous in regards to factor concentration. PCC consistently reversed the INR in patients with intracranial hemorrhage. There is some evidence that PCC may reverse the INR more rapidly compared to fresh frozen plasma. Serious adverse effects were uncommon and included mainly thromboembolism. PCC has features which make it a promising therapy for patients with warfarin-related intracranial hemorrhage, and deserves more rigorous study in prospective-randomized controlled trials.

Original languageEnglish (US)
Pages (from-to)403-413
Number of pages11
JournalNeurocritical Care
Volume12
Issue number3
DOIs
StatePublished - Jun 1 2010
Externally publishedYes

Fingerprint

Intracranial Hemorrhages
Anticoagulants
Warfarin
International Normalized Ratio
Therapeutics
Thromboembolism
prothrombin complex concentrates
Randomized Controlled Trials
Databases
Prospective Studies
Hemorrhage
Mortality

Keywords

  • Coagulopathy
  • Intracerebral hemorrhage
  • Intracranial bleeding
  • Intracranial hemorrhage
  • Oral anticoagulation
  • Prothrombin complex concentrates
  • Vitamin K antagonists
  • Warfarin

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Prothrombin complex concentrates for oral anticoagulant therapy-related intracranial hemorrhage : A review of the literature. / Bershad, Eric M.; Suarez, Jose.

In: Neurocritical Care, Vol. 12, No. 3, 01.06.2010, p. 403-413.

Research output: Contribution to journalReview article

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