Anticoagulant therapy poses a significant risk for patients undergoing emergency neurosurgery procedures, necessitating reversal with prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). Data on PCC efficacy lack consistency in this setting. This systematic review and metaanalysis aimed to evaluate efficacy and safety of PCC for anticoagulation reversal in the context of urgent neurosurgery. Articles from PubMed, Embase, and Cochrane databases were screened according to the PRISMA checklist. Adult patients receiving anticoagulation reversal with PCC for emergency neurosurgical procedures were included. When available, patients who received FFP were included as a comparison group. Pooled estimates of observational studies were calculated for efficacy and safety outcomes via random-effects modeling. Initial search returned 4505 articles, of which 15 studies met the inclusion criteria. Anticoagulants used included warfarin (83%), rivaroxaban (6.8%), phenprocoumon (6.1%), apixaban (2.2%), and dabigatran (1.5%). The mean International Normalized Ratio (INR) prePCC administration ranged from 2.3 to 11.7, while postPCC administration from 1.1 to 1.4. All-cause mortality at 30 days was 27% (95%CI 21, 34%; I² = 44.6%; p-heterogeneity = 0.03) and incidence of thromboembolic events was 6.00% among patients treated with PCC (95%CI 4.00, 10.0%; I² = 0%; p-heterogeneity = 0.83). Results comparing PCC and FFP demonstrated no statistically significant differences in INR reversal, mortality, or incidence of thromboembolic events. This metaanalysis demonstrated adequate safety and efficacy for PCC in the reversal of anticoagulation for urgent neurosurgical procedures. There was no significant difference between PCC and FFP, though further trials would be useful in demonstrating the safety and efficacy of PCC in this setting.

抗凝治疗对接受紧急神经外科手术的患者构成重大风险，需要使用凝血酶原复合物浓缩物 (PCC) 或新鲜冷冻血浆 (FFP) 进行逆转。在这种情况下，PCC 功效的数据缺乏一致性。本系统评价和荟萃分析旨在评估 PCC 在紧急神经外科手术中逆转抗凝的有效性和安全性。根据 PRISMA 检查表筛选来自 PubMed、Embase 和 Cochrane 数据库的文章。包括因急诊神经外科手术而接受 PCC 抗凝逆转的成年患者。如果可用，接受 FFP 的患者被包括为对照组。观察性研究的汇总估计值是通过随机效应模型计算的有效性和安全性结果。初步搜索返回 4505 篇文章，其中 15 项研究符合纳入标准。使用的抗凝剂包括华法林 (83%)、利伐沙班 (6.8%)、苯丙香豆素 (6.1%)、阿哌沙班 (2.2%) 和达比加群 (1.5%)。平均国际标准化比率 (INR) prePCC 给药范围为 2.3 到 11.7，而 postPCC 给药范围为 1.1 到 1.4。30 天时的全因死亡率为 27% (95% CI 21, 34%;我²  = 44.6％; p-异质性 = 0.03），接受 PCC 治疗的患者血栓栓塞事件的发生率为 6.00%（95%CI 4.00，10.0%；I ²  = 0%；p-异质性 = 0.83）。比较 PCC 和 FFP 的结果表明，INR 逆转、死亡率或血栓栓塞事件的发生率没有统计学上的显着差异。该荟萃分析证明了 PCC 在逆转紧急神经外科手术的抗凝治疗方面具有足够的安全性和有效性。PCC 和 FFP 之间没有显着差异，但进一步的试验将有助于证明 PCC 在这种情况下的安全性和有效性。