Fredriksson K, Norrving B, Strömblad L G
Department of Neurology, University Hospital, Lund, Sweden.
Stroke. 1992 Jul;23(7):972-7. doi: 10.1161/01.str.23.7.972.
Although intracerebral hemorrhage is one of the most serious complications during oral anticoagulant therapy, there are no guidelines on emergency treatment with respect to reversal of anticoagulation effect in these patients.
We retrospectively compared laboratory data and clinical features in 17 cases of anticoagulant-related intracerebral hemorrhage treated with prothrombin complex concentrate (n = 10) or fresh-frozen plasma (n = 7).
In the group of patients treated with prothrombin complex concentrate, the mean prothrombin time decreased from 2.83 to 1.22 International Normalized Ratio within 4.8 hours, compared with a decrease from 2.97 to 1.74 within 7.3 hours in those given fresh-frozen plasma (i.e., four to five times more rapidly after treatment with prothrombin complex concentrate) (p less than 0.001). Symptoms and signs of intracerebral hemorrhage, measured on an eight-graded Reaction Level Scale, progressed on average 0.2 grades in patients given prothrombin complex concentrate compared with 1.9 grades in those given fresh-frozen plasma (p less than 0.05). In patients with prothrombin values above 1.46, clinical progression within 12 hours occurred in five of six cases.
Treatment with prothrombin complex concentrate reverses anticoagulation more rapidly than fresh-frozen plasma, which might be of importance for the prevention of further bleeding.
尽管脑出血是口服抗凝治疗期间最严重的并发症之一，但对于这些患者抗凝作用逆转的紧急治疗尚无指南。
我们回顾性比较了17例接受凝血酶原复合物浓缩物治疗（n = 10）或新鲜冷冻血浆治疗（n = 7）的抗凝相关脑出血患者的实验室数据和临床特征。
在接受凝血酶原复合物浓缩物治疗的患者组中，平均凝血酶原时间在4.8小时内从国际标准化比值2.83降至1.22，而接受新鲜冷冻血浆治疗的患者在7.3小时内从2.97降至1.74（即凝血酶原复合物浓缩物治疗后速度快四至五倍）（p < 0.001）。根据八级反应水平量表测量，接受凝血酶原复合物浓缩物治疗的脑出血患者症状和体征平均进展0.2级，而接受新鲜冷冻血浆治疗的患者为1.9级（p < 0.05）。凝血酶原值高于1.46的患者中，六例中有五例在12小时内出现临床进展。
凝血酶原复合物浓缩物治疗比新鲜冷冻血浆更迅速地逆转抗凝作用，这对于预防进一步出血可能具有重要意义。
