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Table 5 Studies investigating the available anticoagulation reversal agents' impact on patient survival

From: Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: a structured literature review

Author

Study type

Patient population

Intervention

Result

Grade [14]

Berwaerts et al. 2000

Retrospective

68 patients with WAICH

19 patients received vitamin K only, 11 vitamin K + FFP, 5 FFP, 3 vitamin K + FFP + factor IX, 2 vitamin K + factor IX, 2 factor IX, and 26 were treated with an "expectant attitude"

No significant difference in mortality rate among patients who had been reversed with any combination of reversal agents or had not been reversed

Low

Sjoblom et al. 2001

Retrospective

136 patients with WAICH who received some form of reversal

Either single therapy or combinations of vitamin K, factor IX, FFP, or no therapy was administered

No evidence that any treatment strategy was superior to the others

Moderate

Huttner et al. 2006

Retrospective

55 patients with WAICH

Compared vitamin K, PCC, and FFP alone or in some combination

Incidence and extent of hematoma growth were significantly lower in the PCC-treated group. If the INR was normalized within 2 h then FFP and PCC influence on hematoma growth were similar

Low

Goldstein et al. 2006

Retrospective

69 patients with non traumatic WAICH with INR > 1.4

Patients received no therapy, FFP, vitamin K, or combination

Patients whose INR was successfully reversed within 24 h had a shorter time from diagnosis to first dose of FFP (90 vs. 210 min). Shorter time to vitamin K as well predicted INR correction. Every 30 min of delay in the first dose of FFP was associated with 20% decreased odds of INR reversal within 24 h. No ED intervention was associated with improved clinical outcome

Moderate

Yasaka et al. 2003

Prospective

15 patients with WAICH

9 PCCs with vitamin K 10-20 mg IV, 2 PCCs alone or 4 with vitamin K 10-20 mg IV alone were administered based on decision of treating MD

Vitamin K lowered the INR after 12-24 h to normalized range. PCC with or without vitamin K was more effective at rapidly correcting the increased INR. PCC without vitamin K administration led to a recurrent increase in INR after 12-24 h

Low