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Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model
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A Low-Dose 4F-PCC Protocol for DOAC-Associated Intracranial Hemorrhage
Karen Berger1, Melissa Santibañez1,2, Lina Lin1,2
1Department of Pharmacy, 159947NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
Journal of Intensive Care Medicine
|April 16, 2019
Summary
A lower dose of 25 units/kg four-factor prothrombin complex concentrate (4F-PCC) effectively achieved hemostasis in patients with direct-acting oral anticoagulant-associated intracranial hemorrhage (ICH). This real-world study observed a 94.7% hemostasis rate with a 9.1% thromboembolic event rate.
Area of Science:
- Neurocritical care
- Hematology
- Pharmacology
Background:
- Current guidelines recommend four-factor prothrombin complex concentrate (4F-PCC) over plasma for warfarin reversal.
- The safety and efficacy of 4F-PCC for direct-acting oral anticoagulants (DOACs), especially in intracranial hemorrhage (ICH), remain under investigation.
Purpose of the Study:
- To evaluate the effectiveness and safety of a lower dose protocol (25 units/kg) of 4F-PCC for managing DOAC-associated ICH in a real-world setting.
Main Methods:
- Retrospective study of adult patients receiving 4F-PCC for DOAC-associated ICH (March 2014 - December 2015).
- Primary outcome: hemostatic effectiveness within 24 hours.
- Secondary outcome: thromboembolic events within 14 days.
Main Results:
- Twenty-two patients were included; hemostasis was evaluable in 19.
- Hemostasis was achieved in 18/19 (94.7%) patients.
- Thromboembolic events occurred in 2/22 (9.1%) patients.
Conclusions:
- A lower dose protocol of 25 units/kg 4F-PCC demonstrated high hemostasis rates in DOAC-associated ICH.
- Two thrombotic events were observed within 14 days of 4F-PCC administration.
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