Aiyagari Venkatesh, Testai Fernando D
Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Curr Opin Crit Care. 2009 Apr;15(2):87-92. doi: 10.1097/MCC.0b013e3283269e4d.
Warfarin is the most commonly used oral anticoagulant. Intracranial hemorrhage is the most serious complication of anticoagulation and the anticoagulant effect of warfarin has to be urgently reversed in this situation. Traditional methods of reversal of the anticoagulant effect of warfarin involving the use of vitamin K and fresh frozen plasma are slow and relatively ineffective and there is a need for alternative treatment approaches.
Agents such as prothrombin complex conjugates and recombinant activated factor VII are being increasingly used to emergently correct warfarin-associated coagulopathy. Over the last decade, several small case series have suggested that these agents may lead to more rapid correction of the INR, however, improved clinical outcome is yet to be proven. A recent small prospective trial has also demonstrated the safety of a prothrombin complex conjugate and its efficacy in rapidly correcting an elevated INR in these patients.
There is a need for well designed randomized clinical trials aimed at evaluating the efficacy of these agents in improving the outcome of patients with anticoagulant associated intracranial hemorrhage.
华法林是最常用的口服抗凝剂。颅内出血是抗凝治疗最严重的并发症，在此情况下必须紧急逆转华法林的抗凝作用。传统的逆转华法林抗凝作用的方法，包括使用维生素K和新鲜冰冻血浆，起效缓慢且效果相对不佳，因此需要其他替代治疗方法。
凝血酶原复合物浓缩剂和重组活化因子VII等药物正越来越多地用于紧急纠正华法林相关凝血病。在过去十年中，多个小型病例系列研究表明，这些药物可能会更快速地纠正国际标准化比值（INR），然而，其能否改善临床结局仍有待证实。最近一项小型前瞻性试验也证明了一种凝血酶原复合物浓缩剂的安全性及其在快速纠正这些患者升高的INR方面的疗效。
需要设计良好的随机临床试验，以评估这些药物在改善抗凝相关颅内出血患者结局方面的疗效。
