Thank you to Dr. Pearsall for today’s Morning Report:
Reversing coumadin-associated ICH: PCC vs FFP
- Vitamin K for sustained reversal of vit-K dependent coag factors (10mg IV slowly)
- Oral anticoagulant therapy increases degree of bleeding, with mortality > 50%
- PCC: inactive vit-K dependent coag factors (II, IX, X & variable amts of VII)
- Two available products in US largely 3-factor, containing little or no VII
- European preparations contain all four; most studies look at products with all four
- PCC vs FFP
- Typically requires < 200mL vs FFP (up to 3 liters); avoids fluid overload
- Dose immediately; no need to wait for thawing or ABO matching
- Lower risk of viral transmission, TRALI, anaphylactoid rxn
- Corrects within 10-30 minutes to an INR level significantly lower than FFP (INR of FFP is approx 1.5)
- Decrease in hematoma expansion, reduced M&M
- Reversal of anticoagulation increases risk of thrombotic events: venous & arterial
Huttner et al. Hematoma growth and outcome in treated neurocritical care pts with ICH related to OAT: comparison of acute treatment strategies using vit K, FFP & PCC. Stroke 2006;37(6):1465-70.
Bechtel et al. Treatments for reversing warfarin anticoagulation in pts with acute ICH: a structured literature review. Int J Emerg Med. 2011;4:40.
Makris et al. Emergency oral anticoagulant reversal: the relative efficacy of infusions of FFP & clotting factor concentrate on correction of the coagulopathy. Throb Haemostasis 1997;77:477-480.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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