Table 1 Studies investigating reversal of warfarin anticoagulation in traumatic intracranial hemorrhage
Author | Study type | Patient population | Intervention | Result | Grade [14] |
|---|---|---|---|---|---|
Bartal et al. 2007 | Prospective | 7 patients on warfarin with traumatic ICH | All received vitamin K and 6-12 units of FFP. INR was still > 1.3 in all, so 40-90 μg/kg rfVIIa was given. INR dropped below 1.3, and all underwent neurosurgery | rfVIIa lowered the INR into operable range in all patients. | Low |
Baldi et al. 2006 | Prospective | 232 on warfarin or acenocumarol or with INR equal or > 2 with spontaneous or traumatic ICH | FFP used in 22% of patients, vitamin K in 41%, PCC in 6% and factor VII concentrate in 3%. Many did not receive any reversal treatment | No statistical differences were found in the outcomes of patients with or without medical therapy | Low |
Kalina et al. 2008 | Prospective | 46 trauma patients on warfarin with ICH with INR > 1.5 | Institution developed protocol for trauma patients with ICH taking warfarin with INR > 1.5. Patients given weight-based dose of PCC (concentrated II, VII, IX, X). All given 5 mg vitamin K as well. Patients could receive FFP as well in protocol group | Protocol resulted in increased number of patients receiving PCC. Protocol patients had improved times to INR normalization, patients having reversal of coagulopathy, and shorter times to surgery. No difference in ICU days, hospital days, or mortality. 2/48 that got PCC had DVT | Low |
Ivascu et al. 2006 | Retrospective | 57 patients with traumatic WAICH from fall or MVC | Established and implemented protocol to treat traumatic WAICH. All 35 protocol patients received FFP. Only 14/22 patients in the pre-protocol group received FFP | Mortality and reversal times of INR were similar between the protocol instituted group and the pre-protocol group | Low |