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Medicina 2018, 54(2), 22; https://doi.org/10.3390/medicina54020022

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.
Received: 9 March 2018 / Revised: 13 April 2018 / Accepted: 19 April 2018 / Published: 25 April 2018
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Abstract

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
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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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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