Four-Factor Prothrombin Complex Concentrate Administration Timing in Oral Anticoagulant-Associated Intracranial...

Area of Science:

• Neurology
• Hematology
• Emergency Medicine

Background:

• Oral anticoagulant-associated intracranial hemorrhage (ICH) carries high morbidity and mortality.
• Rapid hemostatic agent administration is recommended, but optimal timing remains unclear.

Purpose of the Study:

• To determine if 4-factor prothrombin complex concentrate (4F-PCC) time to administration (TTA) affects hematoma expansion or 48-hour mortality in patients with OAC-associated ICH.
• To analyze the impact of 4F-PCC TTA on warfarin, apixaban, or rivaroxaban users.

Main Methods:

• Retrospective cohort study of 66 patients receiving 4F-PCC for OAC-associated ICH.
• Patients categorized by ICH diagnosis location: Emergency Department (ED), inpatient, or outside hospital (OSH).
• Primary outcome: hematoma expansion or mortality within 48 hours of ICH diagnosis.

Main Results:

• The primary outcome occurred in 18 (27.3%) patients (18 with hematoma expansion, 0 with mortality).
• No significant difference in 4F-PCC TTA between patients with and without hematoma expansion (median 107 vs. 115 minutes, P=.81).

Conclusions:

• Time to 4F-PCC administration was not associated with 48-hour hematoma expansion or mortality in OAC-associated ICH.
• Delayed administration may limit 4F-PCC's effectiveness; further research on optimal timing is needed.