Recombinant factor VIIa for warfarin-associated intracranial bleeding.
OBJECTIVE
To examine the efficacy of recombinant factor VIIa (rVIIa) in reversing warfarin-induced coagulopathy in trauma patients presenting with intracranial hemorrhage (ICH).


METHODS
Retrospective, cohort-controlled database review.


METHODS
Level 1, university-affiliated trauma center.


METHODS
54 patients presenting with ICH associated with chronic warfarin therapy, 30 of whom were treated with rVIIa, and the other 24 patients treated conventionally.


METHODS
We examined initial and subsequent coagulation studies (prothrombin time, international normalized ratio [INR]), blood product requirement, and clinical outcome, including time to reverse anticoagulation, duration of reversal, and subsequent mortality.


RESULTS
Patients treated with rVIIa required significantly less plasma (4 vs 7 units) to correct their INR, and corrected in a much shorter period of time (2.4 vs 10 hrs). The duration of corrected INR after rVIIa was dose-dependent.


CONCLUSIONS
Factor rVIIa provides prompt correction of the INR of dose-dependent duration in patients with ICH intracranial hemorrhage associated with warfarin use.
Ilyas
Can
C
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Beyer
Ginine M
GM
Dutton
Richard P
RP
Scalea
Thomas M
TM
Hess
John R
JR
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000188:drug therapy*; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D011994:Recombinant Proteins; D014859:Warfarin; C103587:recombinant FVIIa; D015942:Factor VIIa