Table 2 Studies investigating PCC versus FFP for anticoagulation reversal in warfarin-associated intracranial hemorrhage

Makris et al. 1997

Prospective

16 patients with WAICH, along with 12 "similar subjects"

Vitamin K 1-5 mg IV given to all patients. 16 patients got PCC and 12 FFP

PCC repleted factors II, VII, IX, and X better than FFP. In patients given FFP, INR remained elevated. 28/29 patients given PCC had INR correction

Moderate

Fredriksson et al. 1992

Retrospective

17 patients with WAICH

All patients received vitamin K 10-20 mg IV. Of the 17 total patients, 10 received PCC and 7 received FFP

PCC significantly decreased the INR from 2.83 to 1.22 within 4.8 h, compared with a decrease in INR from 2.97 to 1.74 within 7.3 h in the FFP group. Signs and symptoms of ICH progressed more in those treated with FFP than with PCC

Low

Boulis et al. 1999

Prospective, randomized controlled trial

13 patients with WAICH

All patients received vitamin K 10 mg subcutaneously. 8 patients received FFP. 5 patients received weight-based dosing of factor IX complex concentrate (FIXCC) in addition to FFP

Significant differences were found in time to correction, rate of correction, and volume of FFP required for correction between the FFP group (8.9, 2,700 mL) and the FIXCC + FFP group (2.95, 399 mL)

Moderate

Cartmill et al. 2000

Prospective

12 patients with spontaneous WAICH

6 patients treated with 50 μg/kg IV PCC along with vitamin K 10 mg IV. 6 matched patients treated with 4 units of FFP and vitamin K 10 mg IV. INR re-checked 15 min after treatment

PCC group had significantly faster and complete reversal compared to the FFP group. Mean post-treatment INRs were 1.32 in PCC group and 2.3 in FFP group

Low

Siddiq et al. 2008

Retrospective

19 patients with diagnosis of WAICH

10 patients treated with PCC, vitamin K, and FFP, and 9 patients treated with FFP and vitamin K

PCC along with FFP and vitamin K trends toward faster normalization of INR than with FFP and vitamin K alone

Low