title: Ultra-rapid management of oral anticoagulant therapy-related surgical intracranial hemorrhage.
abstract: OBJECTIVE
  Intracranial hemorrhage in patients receiving oral anticoagulant (OAC) therapy is associated with poor neurological outcome. Prothrombin complex concentrate (PCC) is the gold-standard therapy to normalize hemostasis but remains underused. Ultra-rapid reversal of anticoagulation could reduce the time to biological and surgical hemostasis, and might improve outcome. We report the use of bolus infusions of PCC to immediately reverse anticoagulation and allow for urgent neurosurgical care.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Neurosurgical intensive care unit, university hospital.
  
  
  METHODS
  Eighteen patients with OAC-associated intracranial hemorrhage requiring urgent neurosurgical intervention.
  
  
  METHODS
  All patients received 20 UI/kg of PCC as an intravenous bolus infusion (3 min) and 5 mg of enteral vitamin K. Surgery was started immediately, without waiting for blood sample results.
  
  
  RESULTS
  Serial blood samples were performed to assess prothrombin time. Coagulation was considered normal when the international normalized ratio was </= 1.5. All patients, including nine who were over-anticoagulated, had complete reversal of anticoagulation immediately after the bolus of PCC. No hemorrhagic or thrombotic adverse effect was observed intra- or postoperatively.
  
  
  CONCLUSIONS
  A bolus infusion of PCC completely reverses anticoagulation within 3 min. Neurosurgery can be performed immediately in OAC-related intracranial hemorrhage. This study shows that OAC-treated patients can be managed as rapidly as non-anticoagulated patients.
authors.affiliation: Département d'Anesthésie-Réanimation, AP-HP, Centre hospitalo-universitaire de Bicêtre, 78, rue du Général Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France. bernard.vigue@bct.aphp.fr
authors.forename: Bernard
authors.initials: B
authors.lastname: Vigué
authors.forename: Catherine
authors.initials: C
authors.lastname: Ract
authors.forename: Benjamin
authors.initials: B
authors.lastname: Tremey
authors.forename: Nicolas
authors.initials: N
authors.lastname: Engrand
authors.forename: Pierre Etienne
authors.initials: PE
authors.lastname: Leblanc
authors.forename: Anne
authors.initials: A
authors.lastname: Decaux
authors.forename: Laurent
authors.initials: L
authors.lastname: Martin
authors.forename: Dan
authors.initials: D
authors.lastname: Benhamou
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000188:drug therapy; D008875:Middle Aged; D019635:Neurosurgical Procedures; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates