Successful Cerebral Hemorrhage Control with Prothrombin Complex Concentrate in a Patient on Edoxaban Therapy: A Case Report

Direct oral anticoagulants (DOACs) have demonstrated safety and efficacy in stroke prevention in patients with non-valvular atrial fibrillation (NVAF). In terms of safety, there was a significant reduction of intracranial hemorrhages (ICH) in patients treated with DOACs over warfarin. To date, a specific antidote for edoxaban is not yet available. The management of ICH relies on the use of coagulation factors. This article reports a case of a 73-year-old woman with NVAF who had cerebral hematoma in the right intraparenchymal thalamus-capsular area while on therapy with edoxaban 60 mg/day. The computed tomography (CT) brain scan showed hematoma of >18mm diameter. The patient was timely treated with four-factor prothrombin complex concentrate (4F-PCC) at 50 IU/kg. After 6 hrs patient's symptoms alleviated and she was successfully recovered within 6 days. A repeated CT scan of the brain in 3 weeks showed improvement. The patient's treatment with edoxaban 30 mg/day restarted after 8 weeks.