Reversal strategies and outcomes in patients with atrial fibrillation and warfarin-associated intracranial hemorrhage

•Intracranial hemorrhage is the most serious complication of anticoagulation.•Prothrombin complex concentrates accelerate INR reversal.•Faster INR reversal did not decrease in-hospital intracranial hemorrhage mortality.•Delays in receiving reversal agents may mute the benefit of treatment. Evaluate...

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Bibliographic Details
Published in:Journal of stroke and cerebrovascular diseases 2020-08, Vol.29 (8), p.104903-104903, Article 104903
Main Authors: Singer, Daniel E., Borowsky, Leila H., Regan, Susan, Lee, Jong Woo, Zint, Kristina, Franca, Lionel Riou, Goldstein, Joshua N.
Format: Article
Language:English
Subjects:
Anticoagulation
Atrial fibrillation
Intracranial hemorrhage
Reversal agents
Warfarin
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Summary:•Intracranial hemorrhage is the most serious complication of anticoagulation.•Prothrombin complex concentrates accelerate INR reversal.•Faster INR reversal did not decrease in-hospital intracranial hemorrhage mortality.•Delays in receiving reversal agents may mute the benefit of treatment. Evaluate reversal strategies in atrial fibrillation (AF) patients with warfarin-associated intracranial hemorrhage (ICH) in clinical care. Observational cohort of AF patients with warfarin-associated ICH at two referral hospitals (2007–2010), with patient features, reversal agents, and outcomes collected from medical records. Among 498 ICH patients 403 received fresh frozen plasma (FFP) without 3-factor prothrombin complex concentrates (PCCs) or recombinant factor VIIa (rFVIIa), 65 received PCCs or rFVIIa, mostly with FFP, and 30 received no acute reversal agents. Median time from presentation to reversal agent administration was 3.4 h (IQR 2.3-5.3). INR was reversed to ≤1.4 by 6 h post-presentation in 46% of patients receiving PCCs/rFVIIa versus 15% receiving FFP alone (p
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2020.104903