Effectiveness of Factor IX complex concentrate in reversing warfarin associated coagulopathy for intracerebral hemorrhage.
BACKGROUND
The objective of this study is to show the effectiveness of Factor IX complex concentrate (FIXCC) for rapid reversal of an elevated International Normalized Ratio (INR) in patients with anticoagulation-associated intracerebral hemorrhage (AAICH).


METHODS
We, retrospectively, analyzed the clinical data of 19 patients with the diagnosis of AAICH from January 2005 to May 2006. A comparison was made among patients treated with FFP and Vit.K [FFP-group (n = 9)] and patients treated with FIXCC in addition to FFP and Vit.K [FIXCC-group (n = 10)]. INR of 1.4 or less was taken as target.


RESULTS
Mean INR on admission for FFP and FIXCC group was 1.84 +/- 0.31 and 2.44 +/- 1.48, respectively (P = 0.315). After administration of therapy, the INR was reduced from 1.84 +/- 0.31 to 1.34 +/- 0.08 (P < 0.05) in FFP group and 2.44 +/- 1.48 to 1.34 +/- 0.07 (P < 0.005) in FIXCC group. Three patients in FFP group (33%) and 8 patients in FIXCC group (80%) reached their target INR in 3-4 h after initiation of therapy (P = 0.012). Mean time taken by both FFP and FIXCC groups to reach the target INR was 8.52 +/- 5.60 h and 4.25 +/- 2.12 h, respectively (P < 0.05). The mean rate of INR correction was 0.06 +/- 0.03 and 0.27 +/- 0.25 per hour for the FFP and FIXCC group, respectively (P < 0.005). There was one death in FIX group and two in FFP group and no thrombotic complications.


CONCLUSIONS
Our data suggests that FIXCC in combination with FFP and Vit.K may result in decreased time required when compared to FFP and Vit.K alone for correction of warfarin associated coagulopathy in neurosurgical emergencies.
Siddiq
Farhan
F
Department of Neurology, Thomas Jefferson University, 900 Walnut Street, Suite 200, Philadelphia, PA19107, USA.
Jalil
Abdul
A
McDaniel
Cara
C
Brock
David G
DG
Pineda
Carissa C
CC
Bell
Rodney D
RD
Lee
Kiwon
K
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001778:Blood Coagulation Disorders / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005164:Factor IX / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010949:Plasma; D012189:Retrospective Studies; D016896:Treatment Outcome; D014812:Vitamin K / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D014815:Vitamins; D014812:Vitamin K; D014859:Warfarin; D005164:Factor IX