Key result
Prothrombin complex concentrate was associated with significantly higher survival compared to fresh frozen plasma (75.0% vs. 35.7%, p < 0.05) in LVAD patients with intracerebral hemorrhage.
Why the study?
Does prothrombin complex concentrate improve survival compared to fresh frozen plasma in LVAD patients with warfarin-induced intracerebral hemorrhage?
Cohort (n=38)
Does prothrombin complex concentrate improve survival compared to fresh frozen plasma in LVAD patients with warfarin-induced intracerebral hemorrhage?
Absolute Event Rate: 75% vs 35.7%
p-value: p=< 0.05
In LVAD patients with warfarin-induced intracerebral hemorrhage, reversal with prothrombin complex concentrate is associated with significantly higher survival and subsequent heart transplantation rates compared to fresh frozen plasma.
May support PCC preference for LVAD ICH reversal; leaves open need for randomized confirmation before practice change.
Background: Intracerebral hemorrhage (ICH) is one of the most serious complications in patients supported by a left ventricular assist device (LVAD). We evaluate the efficacy of prothrombin complex concentrate (PCC) for rapid reversal of warfarin-induced anticoagulation in this population. Methods: A total of 38 consecutive ICH events in patients supported by an LVAD between 1996 and 2007 were retrospectively reviewed. Fourteen ICH events were treated with fresh frozen plasma (FFP) (Group FFP) and 24 ICH events were treated with PCC (Group PCC). The efficacy and outcome of PCC administration versus FFP were evaluated. Results: The proportion of patients surviving after an ICH event was significantly smaller in Group FFP than Group PCC (35.7% vs. 75.0%, p < 0.05). None of the patients in Group FFP were able to undergo heart transplantation, whereas 21.4% patients in Group PCC successfully underwent heart transplantation. Conclusion: Patients on LVAD are in need for intensified anticoagulation and are at high risk of ICH; therefore, adequate use of PCC in the event of ICH could be of importance for survival and allow subsequent heart transplantation.
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Takahashi et al. (2010) conducted a cohort in Intracerebral hemorrhage in patients supported by a left ventricular assist device (n=38). Prothrombin complex concentrate (PCC) vs. Fresh frozen plasma (FFP) was evaluated on Survival after an ICH event (p=< 0.05). Prothrombin complex concentrate was associated with significantly higher survival compared to fresh frozen plasma (75.0% vs. 35.7%, p < 0.05) in LVAD patients with intracerebral hemorrhage.
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