Ischemic Stroke Symptoms After Warfarin Reversal With 4-Factor Prothrombin Complex Concentrate Case Report.

An 83-year-old woman with atrial fibrillation on chronic warfarin therapy was given 4-factor prothrombin complex concentrate to reverse her warfarin for surgery. She had fallen off a step stool at home and fractured her left wrist which initially the surgeon was going to repair surgically. The day after she received 4-factor prothrombin complex concentrate, she developed stroke-like symptoms, National Institutes of Health Stroke Scale (NIHSS) was 14, and met criteria for tissue plasminogen activator (tPA) administration. Tissue plasminogen activator was administered and she was transferred to the intensive care unit (ICU), per hospital protocol. She remained in the ICU for 24 hours for follow-up and monitoring. Her warfarin was restarted and bridged with enoxaparin. She was not a candidate for antiplatelet therapy due to her history of a gastrointestinal (GI) bleed. At discharge, she had no residual effects from her stroke-like symptoms and a magnetic resonance imaging (MRI) of her brain was negative for an acute cerebrovascular accident (CVA).