Carothers Chancey, Giancarelli Amanda, Ibrahim Joseph, Hobbs Brandon
Department of Pharmacy, Orlando Regional Medical Center, Orlando, Florida.
Department of Pharmacy, Orlando Regional Medical Center, Orlando, Florida.
J Surg Res. 2018 Mar;223:183-187. doi: 10.1016/j.jss.2017.11.008. Epub 2017 Dec 1.
Patients with traumatic intracranial hemorrhage (TIH) anticoagulated with warfarin are at an increased risk of mortality. Fresh frozen plasma (FFP) and vitamin K have been the standard treatment for warfarin reversal; however, guidelines now recommend the use of prothrombin complex concentrate (PCC) for warfarin reversal in patients with life-threatening bleeding. Our protocol uses one vial (∼1000 units) of activated PCC (aPCC) for warfarin reversal, regardless of the weight or presenting international normalized ratio (INR). The purpose of this study was to determine the safety and efficacy of using fixed, low-dose aPCC for warfarin reversal in patients with TIH.
This was a retrospective chart review that included patients with an Abbreviated Injury Scale Head score of ≥3, TIH, and initial INR ≥ 1.5 on warfarin. Patients aged <18 years and those with no repeat INR were excluded. The primary outcome was to compare the percentage of patients with INR ≤ 1.4 after receiving aPCC versus FFP within 24 hours.
Eighty-nine patients were in the FFP group and 31 patients in the aPCC group. The INR was reversed more effectively in the aPCC group compared with the FFP group (90.3% versus 69.7%, P = 0.029). The median time (hours) to reversal was also significantly shorter in the aPCC group compared with the FFP group (3.75 versus 6.75, P = 0.003). However, there was no difference in mortality (35.5% aPCC versus 22.2% control, P = 0.162) or incidences of thrombosis.
Fixed, low-dose aPCC is safe and more effective at reversing the effects of warfarin than FFP in patients with TIH.
使用华法林抗凝的创伤性颅内出血（TIH）患者死亡风险增加。新鲜冰冻血浆（FFP）和维生素K一直是华法林逆转的标准治疗方法；然而，现在的指南推荐在有危及生命出血的患者中使用凝血酶原复合物浓缩剂（PCC）进行华法林逆转。我们的方案使用一瓶（约1000单位）活化PCC（aPCC）进行华法林逆转，无论患者体重或初始国际标准化比值（INR）如何。本研究的目的是确定使用固定低剂量aPCC对TIH患者进行华法林逆转的安全性和有效性。
这是一项回顾性病历审查，纳入了简略损伤量表头部评分≥3、TIH且初始服用华法林时INR≥1.5的患者。排除年龄<18岁的患者和未重复检测INR的患者。主要结局是比较接受aPCC与FFP治疗后24小时内INR≤1.4的患者百分比。
FFP组有89例患者，aPCC组有31例患者。与FFP组相比，aPCC组INR逆转更有效（90.3%对69.7%，P = 0.029）。与FFP组相比，aPCC组逆转的中位时间（小时）也显著更短（3.75对6.75，P = 0.003）。然而，死亡率（aPCC组为35.5%，对照组为22.2%，P = 0.162）或血栓形成发生率没有差异。
对于TIH患者，固定低剂量aPCC在逆转华法林作用方面比FFP更安全、更有效。
