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Open AccessArticle

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

1
Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania
2
Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania
3
Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania
4
Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2018, 54(2), 22; https://doi.org/10.3390/medicina54020022
Received: 9 March 2018 / Revised: 13 April 2018 / Accepted: 19 April 2018 / Published: 25 April 2018
Objective: The number of patients presenting with warfarin-associated intracranial bleeding and needing neurosurgical intervention is growing. Prothrombin complex concentrate (PCC) is commonly used for anti-coagulation reversal before emergent surgery. We present our experience with PCC use in patients presenting with coagulopathy and needing urgent craniotomy. Methods: We retrospectively identified all patients presenting with intracranial bleeding and coagulopathy due to warfarin use, requiring urgent neurosurgical procedures, from January, 2014 (implementation of 4-PCC therapy) until December, 2016. For coagulation reversal, all patients received 4-PCC (Octaplex) and vitamin K. Results: Thirty-five consecutive patients (17 men; median age 72 years) were administered 4-PCC before emergent neurosurgical procedures. The majority of patients presented with traumatic subdural hematoma (62%) and spontaneous intracerebral hemorrhage (32%). All patients were taking warfarin. Median international normalized ratio (INR) on admission was 2.94 (range: 1.20 to 8.60). Median 4-PCC dose was 2000 I.U. (range: 500 I.U. to 3000 I.U.). There was a statically significant decrease in INR (p < 0.01), PT (p < 0.01), and PTT (p = 0.02) after 4-PCC administration. Postoperative INR values were ≤3.00 in all patients, and seven (20%) patients had normal INR values. There were no 4-PCC related complications. Four (11%) patients developed subdural/epidural hematoma and 20 (57%) patients died. Mortality was associated with lower Glasgow coma scale (GCS) score. Conclusions: The 4-PCC facilitates INR reversal and surgery in patients presenting with warfarin-associated coagulopathy and intracranial bleeding requiring urgent neurosurgical intervention. View Full-Text
Keywords: intracranial hemorrhage; warfarin; prothrombin complex concentrate intracranial hemorrhage; warfarin; prothrombin complex concentrate
MDPI and ACS Style

Mačiukaitienė, J.; Bilskienė, D.; Tamašauskas, A.; Bunevičius, A. Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience. Medicina 2018, 54, 22.

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