An Analysis of Outcomes after Administration of Four Factor Prothrombin Complex Concentrate for Urgent Reversal of Anticoagulation in Patients with Intracranial Hemorrhage
2019
Introduction: Four factor prothrombin complex concentrate (PCC4) and vitamin K are used for urgent reversal of coagulopathy
in patients with intracranial hemorrhage while on vitamin K antagonists (VKA) and factor Xa inhibitors. Evaluation in a ‘real
world’ population has not been performed.
Material and methods: Retrospective review of 110 patients with hemorrhagic stroke (n=75) or traumatic ICH (n= 35) at a
comprehensive stroke and trauma center, from 9/2013 and 12/2016. PCC4 was used to reverse coagulopathy in VKA-related
ICH in 75 patients and for factor Xa inhibitors in 35 patients.
Results: Between patient groups taking VKA and factor Xa inhibitors, there was no difference in Glasgow Coma Scale (GCS),
or Marshall and Rotterdam CT scores. No differences were noted between VKA and factor Xa inhibitor-related ICH in median
size of ICH on initial (p=0.69) or repeat (p=0.35) imaging. No difference was noted in ICH size progression (p=0.99). Rates of
thromboembolic complications were noted in 13.3% of patients taking VKAs, higher than that reported in the literature. This
relative hypercoagulable response was not noted in patients taking factor Xa inhibitors, as 0% suffered a thromboembolic event.
Conclusion: Despite arrest of ICH progression in most patients, the high rate of thromboembolic events in the VKA population
suggests the risk of adverse events in a “real world” population is not insignificant and must be considered with respect to the
clinical picture. Further studies are necessary to determine which patients are ideally suited to undergo repletion with PCC4
using expanded criteria.
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