Recombinant Factor VIIa for Reversal of Warfarin Anticoagulation in Intracranial Hemorrhage

Warfarin-related intracranial hemorrhage (ICH) is a medical emergency. Rapid reversal of warfarin anticoagulation is needed to prevent hematoma growth. Current therapy with vitamin K and fresh-frozen plasma (FFP) may be too slow in certain situations. Seven patients with ICH and eight patients with traumatic intracranial hemorrhage received 80 μg of recombinant activated factor VII (FVII) per kilogram in combination with vitamin K for emergency reversal of warfarin. One patient with ICH was treated with FVII only, to temporarily reverse anticoagulation. No patients were treated with FFP. The median age of the patients, seven males and nine females, is 78.6. After initial FVII administration, the international normalized ratio (INR) decreased from a mean 3.7 (1.45–13.08) to around 1.0 except for two cases. The INR of these two cases decreased a few hours later. Only one patient treated for occlusion at the femoral artery had a recurrence of thromboembolic occlusion after one week. The most common indications for anticoagulation were atrial fibrillation, prothetic valve, deep vein thrombosis, and peripheral artery thrombosis. FVII is safe and highly effective when emergency reversal of coagulopathy is desired. But further study is necessary to demonstrate improvement of patient outcome.