Stroke, Vol 23, 972-977, Copyright © 1992 by American Heart Association
K Fredriksson, B Norrving and LG Stromblad
BACKGROUND AND PURPOSE: Although intracerebral hemorrhage is one of the
most serious complications during oral anticoagulant therapy, there are no
guidelines on emergency treatment with respect to reversal of
anticoagulation effect in these patients. METHODS: We retrospectively
compared laboratory data and clinical features in 17 cases of
anticoagulant-related intracerebral hemorrhage treated with prothrombin
complex concentrate (n = 10) or fresh-frozen plasma (n = 7). RESULTS: In
the group of patients treated with prothrombin complex concentrate, the
mean prothrombin time decreased from 2.83 to 1.22 International Normalized
Ratio within 4.8 hours, compared with a decrease from 2.97 to 1.74 within
7.3 hours in those given fresh-frozen plasma (i.e., four to five times more
rapidly after treatment with prothrombin complex concentrate) (p less than
0.001). Symptoms and signs of intracerebral hemorrhage, measured on an
eight-graded Reaction Level Scale, progressed on average 0.2 grades in
patients given prothrombin complex concentrate compared with 1.9 grades in
those given fresh-frozen plasma (p less than 0.05). In patients with
prothrombin values above 1.46, clinical progression within 12 hours
occurred in five of six cases. CONCLUSIONS: Treatment with prothrombin
complex concentrate reverses anticoagulation more rapidly than fresh-frozen
plasma, which might be of importance for the prevention of further
bleeding.
ARTICLES
Emergency reversal of anticoagulation after intracerebral hemorrhage
Department of Neurology, University Hospital, Lund, Sweden.
This article has been cited by other articles:
 |
|
 |
|
  J. Broderick, S. Connolly, E. Feldmann, D. Hanley, C. Kase, D. Krieger, M. Mayberg, L. Morgenstern, C. S. Ogilvy, P. Vespa, et al. REPRINT: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults: 2007 Update: A Guideline From the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, October 16, 2007; 116(16): e391 - e413. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Broderick, S. Connolly, E. Feldmann, D. Hanley, C. Kase, D. Krieger, M. Mayberg, L. Morgenstern, C. S. Ogilvy, P. Vespa, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults: 2007 Update: A Guideline From the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke, June 1, 2007; 38(6): 2001 - 2023. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Dawson and M. Walters New and emerging treatments for stroke Br. Med. Bull., November 7, 2006; (2006) ldl011v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. B. Huttner, P. D. Schellinger, M. Hartmann, M. Kohrmann, E. Juettler, J. Wikner, S. Mueller, U. Meyding-Lamade, R. Strobl, U. Mansmann, et al. Hematoma Growth and Outcome in Treated Neurocritical Care Patients With Intracerebral Hemorrhage Related to Oral Anticoagulant Therapy: Comparison of Acute Treatment Strategies Using Vitamin K, Fresh Frozen Plasma, and Prothrombin Complex Concentrates Stroke, June 1, 2006; 37(6): 1465 - 1470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Steiner, J. Rosand, and M. Diringer Intracerebral Hemorrhage Associated With Oral Anticoagulant Therapy: Current Practices and Unresolved Questions Stroke, January 1, 2006; 37(1): 256 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J P Hanley Warfarin reversal J. Clin. Pathol., November 1, 2004; 57(11): 1132 - 1139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Smythe, W. E. Dager, and N. M. Patel Managing Complications of Anticoagulant Therapy Journal of Pharmacy Practice, October 1, 2004; 17(5): 327 - 346. [Abstract] [PDF]
|
|
|
|
 |
|
 J. Rosand, M. H. Eckman, K. A. Knudsen, D. E. Singer, and S. M. Greenberg The Effect of Warfarin and Intensity of Anticoagulation on Outcome of Intracerebral Hemorrhage Arch Intern Med, April 26, 2004; 164(8): 880 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Mayer Ultra-Early Hemostatic Therapy for Intracerebral Hemorrhage Stroke, January 1, 2003; 34(1): 224 - 229. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Man-Son-Hing and A. Laupacis Balancing the Risks of Stroke and Upper Gastrointestinal Tract Bleeding in Older Patients With Atrial Fibrillation Arch Intern Med, March 11, 2002; 162(5): 541 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Sjoblom, H.-G. Hardemark, A. Lindgren, B. Norrving, M. Fahlen, M. Samuelsson, L. Stigendal, D. Stockelberg, A. Taghavi, L. Wallrup, et al. Management and Prognostic Features of Intracerebral Hemorrhage During Anticoagulant Therapy: A Swedish Multicenter Study Stroke, November 1, 2001; 32(11): 2567 - 2574. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Crawley, D. Bevan, and D. Wren Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves J. Neurol. Neurosurg. Psychiatry, September 1, 2000; 69(3): 396 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Berwaerts and J. Webster Analysis of risk factors involved in oral-anticoagulant-related intracranial haemorrhages QJM, August 1, 2000; 93(8): 513 - 521. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Man-Son-Hing, G. Nichol, A. Lau, and A. Laupacis Choosing Antithrombotic Therapy for Elderly Patients With Atrial Fibrillation Who Are at Risk for Falls Arch Intern Med, April 12, 1999; 159(7): 677 - 685. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Hart, B. S. Boop, and D. C. Anderson Oral Anticoagulants and Intracranial Hemorrhage : Facts and Hypotheses Stroke, August 1, 1995; 26(8): 1471 - 1477. [Abstract] [Full Text]
|
|