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(Stroke. 2006;37:6.)
© 2006 American Heart Association, Inc.

Editorial

Treating Warfarin-Related Intracerebral Hemorrhage

Is Fresh Frozen Plasma Enough?

J. Claude Hemphill, III, MD

From the Department of Neurology, University of California, San Francisco.

Correspondence to J. Claude Hemphill III, MD, Department of Neurology, Room 4M62, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110. E-mail jchiii@itsa.ucsf.edu

Key Words: anticoagulation • intracerebral hemorrhage • warfarin

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 151–155

Intracranial hemorrhage, specifically spontaneous intracerebral hemorrhage (ICH), is the most feared complication of warfarin therapy. Although occurring infrequently (<1% per year) in clinical trials of warfarin and stroke prevention in nonvalvular atrial fibrillation,¹ the real risk in community practice may be higher. Warfarin worsens the severity of hemorrhage and dramatically increases the risk of mortality from ICH.² Because of this, most consensus guidelines for the management of anticoagulation-related intracranial hemorrhage recommend urgent correction of the international normalized ratio (INR) to near normal values while acknowledging the lack of randomized trials addressing this treatment approach.^3,4

In this issue of Stroke, Goldstein et al describe their experience at a single institution regarding the effectiveness of an anticoagulation reversal strategy which used primarily fresh frozen plasma (FFP) and, in most cases, vitamin K.⁵ Of 69 patients included in the analysis, 57 (83%) had successful reversal of warfarin coagulopathy (defined as an INR 1.4) within 24 hours of arrival in the emergency department (ED). The group of patients with successful INR reversal within 24 hours had a significantly shorter duration from ICH diagnosis (defined as time of computed tomography scan) to initiation of FFP infusion. Patients who received FFP earlier tended to be older, more neurologically impaired (lower Glasgow Coma Scale score), and have a higher INR, although none of these differences were statistically significant. Patients transferred from an outside hospital had an almost doubling of the mean time to FFP initiation (208 minutes versus 113 minutes; . . . [Full Text of this Article]

Related Article:

Timing of Fresh Frozen Plasma Administration and Rapid Correction of Coagulopathy in Warfarin-Related Intracerebral Hemorrhage

Joshua N. Goldstein, Stephen H. Thomas, Virginia Frontiero, Annelise Joseph, Chana Engel, Ryan Snider, Eric E. Smith, Stephen M. Greenberg, and Jonathan Rosand
Stroke 2006 37: 151-155. [Abstract] [Full Text] [PDF]

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