title: Recombinant coagulation factor VIIa for rapid preoperative correction of warfarin-related coagulopathy in patients with acute subdural hematoma.
abstract: BACKGROUND
  Intracranial hemorrhage, either spontaneous or traumatic is a well-known and potentially lethal complication of Warfarin treatment. Patients with Warfarin-related intracranial hemorrhage need urgent reversal of anticoagulation that must be especially rapid if surgical intervention is indicated. The traditional treatment with fresh frozen plasma (FFP) and vitamin K often fails to achieve the desired correction of coagulopathy in urgent neurosurgical settings.
  
  
  METHODS
  In the present case Recombinant Coagulation Factor VIIa (rFVIIa) was used for preoperative reversal of Warfarin-related coagulopathy. The patient was a fifty two years old man, mechanic valve recipient with Warfarin-induced coagulopathy: International Normalization Ratio (INR) of 6.39, who suffered from acute subdural hematoma and needed urgent neurosurgical intervention. He received a single dose of rFVIIa 120 mg/kg and immediately underwent craniotomy and evacuation of the hematoma. Appropriate hemostasis was achieved during surgery and coagulation test taken two hours after rFVIIa injection revealed INR of 1.25. The INR remained normalized for additional 14 hours. To the best of our knowledge, this is the first report on the use of rFVIIa in the preoperative management of Warfarin-induced intracranial hemorrhage.
  
  
  RESULTS
  Recombinant Coagulation Factor VIIa provides rapid correction of coagulation to a level that allows safe neurosurgical intervention without significant delay. This agent is safe and effective; and should be considered for reversal of Warfarin-induced coagulopathy in cases of intracranial hemorrhage, especially when urgent surgical intervention is required.
authors.affiliation: Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Veshchev
authors.forename: Hanoch
authors.initials: H
authors.lastname: Elran
authors.forename: Khalil
authors.initials: K
authors.lastname: Salame
mesh_terms: D003399:Craniotomy; D015942:Factor VIIa / Q000008:administration & dosage*; D006350:Heart Valve Prosthesis; D020199:Hematoma, Subdural, Acute / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011994:Recombinant Proteins / Q000008:administration & dosage; D014859:Warfarin / Q000009:adverse effects
chemical_list: D011994:Recombinant Proteins; D014859:Warfarin; D015942:Factor VIIa