Table 4 Studies investigating multiple treatment options for anticoagulation reversal in warfarin-associated intracranial hemorrhage
Author | Study type | Patient population | Intervention | Result | Grade [14] |
|---|---|---|---|---|---|
Rabinstein and Wijdicks 2007 | Retrospective | 13 patients with spontaneous WAICH | Vitamin K and FFP in "doses deemed appropriate for each case." Neurosurgical intervention once INR < 1.4 | Median time to reversal 6.5 h (INR < 1.4). Recovery in 65% of those patients who fully awoke within 36 h after evacuation | Low |
Yasaka et al. 2005 | Prospective | 35 patients with WAICH | Varying doses of PCC (200- 1,500 IU) were given to see what the optimal dose was for INR correction | 200 IU did not decrease 50% of the patients below 2.0 INR. 500 IU decreased the INR to < 1.5 in 96% of patients with initial INR < 5.0. All patients treated with 1,000 IU-1,500 IU had INR decrease to < 1.3 | Low |
Preston 2002 | Prospective | 10 patients with WAICH | PCC dose range 25-50 μg/kg was used in each patient as reversal as well as vitamin K 2-5 mg IV | Median INR was 3.98 prior to treatment and 20 min after treatment < 1.9 with almost all < 1.3 | Low |
Nitu et al. 1998 | Retrospective | 1 patient with WAICH; 17 patients on warfarin with other bleeding | Factor IX and factor VII concentrate given to patients | INR in the patient with ICH went from 5.9 to post-treatment 1.8 within 15 min | Low |
Lee et al. 2006 | Retrospective | 45 patients with WAICH | Varying doses of FFP and vitamin K were given for reversal | The median time for door to INR normalization was 30 h (14 to 49.5), with 4 patients' hematomas enlarging after INR normalization | Low |