Key result
Aggressive treatment with ≥3 U of fresh-frozen plasma or recombinant activated Factor VIIa before interhospital transfer was associated with lower repeat INRs and better discharge dispositions.
Why the study?
Does aggressive acute reversal therapy before interhospital transfer improve outcomes in patients with warfarin-associated intracerebral hemorrhage?
Observational (n=56)
Yes
Does aggressive acute reversal therapy before interhospital transfer improve outcomes in patients with warfarin-associated intracerebral hemorrhage?
Treatment of warfarin-associated intracerebral hemorrhage in community emergency departments is often suboptimal, and aggressive coagulopathy reversal before interhospital transfer may improve clinical outcomes.
May support pre-transfer aggressive reversal in warfarin-ICH; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND AND PURPOSE: The purpose of this study was to investigate time delays, adherence to guidelines, and their impact on outcomes in patients with warfarin-associated intracerebral hemorrhage transferred from community emergency departments to a comprehensive stroke center. METHODS: We collected demographic, clinical, transfer time, treatment, and outcome data for patients transferred to our institution with warfarin-associated intracerebral hemorrhage from community emergency departments. RESULTS: Among 928 patients with intracerebral hemorrhage, 56 (6%) with warfarin-associated intracerebral hemorrhage (median international normalized ratio, 2.55) were transferred to the comprehensive stroke center. Twenty patients received no acute reversal therapy before transfer, only 4 of whom had international normalized ratios ≤1.4 in the community emergency department. Median time of emergency department stay was 3.66 hours and median time to initiation of acute reversal therapy was 4.48 hours. Those who received ≥3 U of fresh-frozen plasma or recombinant activated Factor VIIa (11 patients) before transfer had lower repeat international normalized ratios and better discharge dispositions than those treated less aggressively. CONCLUSIONS: Treatment of warfarin-associated intracerebral hemorrhage in community emergency departments is often suboptimal and does not adhere to published guidelines. Treating coagulopathy aggressively before interhospital transfer may improve outcomes and warrants further investigation.
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Liotta et al. (2012) conducted an observational in Warfarin-associated intracerebral hemorrhage (n=56). Acute reversal therapy (fresh-frozen plasma or recombinant activated Factor VIIa) vs. Less aggressive or no acute reversal therapy was evaluated on Repeat international normalized ratios and discharge dispositions. Aggressive treatment with ≥3 U of fresh-frozen plasma or recombinant activated Factor VIIa before interhospital transfer was associated with lower repeat INRs and better discharge dispositions.
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