Baylor College of Medicine, Houston, TX, USA.
Neurocrit Care. 2010 Jun;12(3):403-13. doi: 10.1007/s12028-009-9310-0.
Warfarin-related intracranial hemorrhage carries a high mortality and poor neurological outcome. Rapid reversal of coagulopathy is a cornerstone of medical therapy to halt bleeding progression; however the optimal approach remains undefined. Prothrombin complex concentrates have promising features that may rapidly reverse coagulopathy, but remain relatively unstudied. We aim to review the literature regarding the use of prothrombin complex concentrates in patients with warfarin-related intracranial hemorrhage. A comprehensive review of the literature was conducted using PUBMED and Google Scholar databases to identify the use of PCC in patients with warfarin-related intracranial hemorrhage. The characteristics abstracted included the type of PCC, dosing, study design, type of intracranial hemorrhage, changes in the INR, and adverse effects. Prothrombin complex concentrates are heterogeneous in regards to factor concentration. PCC consistently reversed the INR in patients with intracranial hemorrhage. There is some evidence that PCC may reverse the INR more rapidly compared to fresh frozen plasma. Serious adverse effects were uncommon and included mainly thromboembolism. PCC has features which make it a promising therapy for patients with warfarin-related intracranial hemorrhage, and deserves more rigorous study in prospective-randomized controlled trials.
华法林相关颅内出血死亡率高，神经预后差。迅速纠正凝血异常是停止出血进展的医学治疗基石；然而，最佳方法仍未确定。凝血酶原复合物浓缩物具有迅速纠正凝血异常的良好特性，但研究相对较少。我们旨在综述关于凝血酶原复合物浓缩物在华法林相关颅内出血患者中的应用的文献。使用 PUBMED 和 Google Scholar 数据库进行全面文献复习，以确定凝血酶原复合物浓缩物在华法林相关颅内出血患者中的应用。提取的特征包括 PCC 类型、剂量、研究设计、颅内出血类型、INR 变化和不良反应。凝血酶原复合物浓缩物在因子浓度方面存在异质性。PCC 一致地逆转了颅内出血患者的 INR。有证据表明，PCC 可能比新鲜冷冻血浆更快地逆转 INR。严重不良反应并不常见，主要包括血栓栓塞。凝血酶原复合物浓缩物具有一些特性，使其成为华法林相关颅内出血患者有前途的治疗方法，值得在前瞻性随机对照试验中进行更严格的研究。
