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Reversal strategies and outcomes in patients with atrial fibrillation and warfarin-associated intracranial hemorrhage.
Journal of Stroke & Cerebrovascular Diseases ( IF 2.5 ) Pub Date : 2020-05-24 , DOI: 10.1016/j.jstrokecerebrovasdis.2020.104903
Daniel E Singer 1 , Leila H Borowsky 2 , Susan Regan 1 , Jong Woo Lee 3 , Kristina Zint 4 , Lionel Riou Franca 4 , Joshua N Goldstein 5
Affiliation  

Purpose

Evaluate reversal strategies in atrial fibrillation (AF) patients with warfarin-associated intracranial hemorrhage (ICH) in clinical care.

Materials and Methods

Observational cohort of AF patients with warfarin-associated ICH at two referral hospitals (2007–2010), with patient features, reversal agents, and outcomes collected from medical records.

Results

Among 498 ICH patients 403 received fresh frozen plasma (FFP) without 3-factor prothrombin complex concentrates (PCCs) or recombinant factor VIIa (rFVIIa), 65 received PCCs or rFVIIa, mostly with FFP, and 30 received no acute reversal agents. Median time from presentation to reversal agent administration was 3.4 h (IQR 2.3-5.3). INR was reversed to ≤1.4 by 6 h post-presentation in 46% of patients receiving PCCs/rFVIIa versus 15% receiving FFP alone (p<0.0001). Among PCCs/rFVIIa recipients, 31% died in-hospital vs. 24% receiving FFP alone (p=0.27). Adjusted OR for death accounting for age and Glasgow Coma Score was 0.78 (0.36–1.69) for PCCs/rFVIIa vs FFP only and 1.16 (0.59-2.27) comparing those reaching vs. not reaching INR ≤ 1.4 at 6 h.

Conclusions

Treatment with PCCs/rFVIIa led to faster INR reversal than treatment with FFP alone. Neither treatment with PCCs/rFVIIa nor rapid INR reversal was associated with improved survival. Delays receiving PCCs may largely eliminate the benefit of treatment.



中文翻译:

心房颤动和华法林相关颅内出血患者的逆转策略和结果。

目的

在临床护理中评估华法林相关颅内出血(ICH)的房颤(AF)患者的逆转策略。

材料和方法

两家转诊医院(2007-2010年)的房颤患者与华法林相关性ICH的观察队列,包括患者特征,逆转药物和从医疗记录中收集的结局。

结果

在498例ICH患者中,有403例接受了新鲜的冷冻血浆(FFP),而没有三因子凝血酶原复合物浓缩物(PCC)或重组VIIa因子(rFVIIa),其中65例接受了PCC或rFVIIa,大多数为FFP,而30例未接受急性逆转剂。从出现到服用逆转药物的中位时间为3.4小时(IQR 2.3-5.3)。呈现后6 h,接受PCCs / rFVIIa的患者INR下降至≤1.4,而仅接受FFP的患者则为15%(p <0.0001)。在PCC / rFVIIa接受者中,有31%在医院内死亡,而仅接受FFP的则为24%(p = 0.27)。PCCs / rFVIIa与仅FFP的死亡占校正年龄和格拉斯哥昏迷评分的校正后OR为0.78(0.36-1.69),而在6小时达到或未达到INR≤1.4的人群,校正后的OR为1.16(0.59-2.27)。

结论

PCCs / rFVIIa的治疗比单独FFP的治疗导致更快的INR逆转。用PCCs / rFVIIa进行治疗或快速逆转INR均与提高生存率无关。延迟接受PCC可能会大大消除治疗的益处。

更新日期:2020-05-24
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