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A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
Published on: June 4, 2021
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Ischemic Stroke Symptoms After Warfarin Reversal With 4-Factor Prothrombin Complex Concentrate Case Report
1Stormont-Vail Healthcare, Topeka, KS, USA.
Hospital Pharmacy
|January 28, 2020
Summary
An elderly woman on warfarin experienced stroke-like symptoms after receiving 4-factor prothrombin complex concentrate. Prompt tissue plasminogen activator (tPA) treatment led to full recovery with no acute cerebrovascular accident (CVA) detected on MRI.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- An 83-year-old woman with atrial fibrillation was on chronic warfarin therapy.
- She sustained a wrist fracture requiring surgical repair.
- Warfarin reversal was initiated with 4-factor prothrombin complex concentrate.
Purpose of the Study:
- To report a case of stroke-like symptoms following warfarin reversal.
- To evaluate the management and outcome of this neurological event.
Main Methods:
- Administration of 4-factor prothrombin complex concentrate for warfarin reversal.
- Assessment of neurological status using the National Institutes of Health Stroke Scale (NIHSS).
- Treatment with tissue plasminogen activator (tPA) for acute stroke symptoms.
Main Results:
- The patient developed stroke-like symptoms (NIHSS 14) the day after receiving 4-factor PCC.
- tPA was administered, and the patient was monitored in the ICU.
- Warfarin was restarted and bridged with enoxaparin; antiplatelet therapy was contraindicated due to GI bleed history.
Conclusions:
- The patient experienced a transient neurological event, not an acute cerebrovascular accident (CVA).
- MRI confirmed no acute CVA.
- The patient recovered without residual deficits.
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