Key result
Prothrombin complex concentrate with vitamin K normalized INR within minutes in a 71-year-old male with a subdural hematoma on warfarin, allowing complication-free neurosurgery.
Why the study?
Does prothrombin complex concentrate with vitamin K rapidly reverse anticoagulation in a patient with warfarin-associated intracranial hemorrhage?
Case Report (n=1)
Does prothrombin complex concentrate with vitamin K rapidly reverse anticoagulation in a patient with warfarin-associated intracranial hemorrhage?
Prothrombin complex concentrate with vitamin K rapidly normalizes INR in patients with warfarin-associated intracranial hemorrhage, enabling safe surgical intervention.
Rapid reversal enabled surgery in this case; leaves open whether PCC plus vitamin K improves outcomes in warfarin-associated ICH.
BACKGROUND: Oral anticoagulant therapy (OAT) is used to prevent/treat thromboembolism. Major bleeding is common in patients on OAT; eg, warfarin increases intracranial hemorrhage (ICH) risk. CASE: A 71-year-old male on warfarin (to reduce stroke risk) presented at Accident and Emergency Minor Injuries Unit with headache after reportedly sounding 'drunk'. On triage, the patient appeared lucid and well. However, International Normalized Ratio (INR) was 4.1. Head computed tomography (CT) indicated a large right-sided subdural hematoma. Prothrombin complex concentrate (PCC; Beriplex(®) P/N, CSL Behring) with vitamin K normalized the INR within minutes of administration. The patient underwent neurosurgery without complications, and was discharged after 5 days, with no residual neurological symptoms. CONCLUSIONS: ICH patients can present with no neurological signs. In OAT patients with headache, INR must be established; if ≥3.0, normalization of INR and head CT are essential. PCC is the best option to rapidly reverse anticoagulation and correct INR pre-surgery.
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Yun Wong (2011) conducted a case report in Intracranial hemorrhage (subdural hematoma) on warfarin therapy (n=1). Prothrombin complex concentrate (PCC) with vitamin K was evaluated on INR normalization and surgical outcome. Prothrombin complex concentrate with vitamin K normalized INR within minutes in a 71-year-old male with a subdural hematoma on warfarin, allowing complication-free neurosurgery.
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