Correction of coagulopathy in warfarin associated cerebral hemorrhage.
OBJECTIVE
Warfarin is the most commonly used oral anticoagulant. Intracranial hemorrhage is the most serious complication of anticoagulation and the anticoagulant effect of warfarin has to be urgently reversed in this situation. Traditional methods of reversal of the anticoagulant effect of warfarin involving the use of vitamin K and fresh frozen plasma are slow and relatively ineffective and there is a need for alternative treatment approaches.


RESULTS
Agents such as prothrombin complex conjugates and recombinant activated factor VII are being increasingly used to emergently correct warfarin-associated coagulopathy. Over the last decade, several small case series have suggested that these agents may lead to more rapid correction of the INR, however, improved clinical outcome is yet to be proven. A recent small prospective trial has also demonstrated the safety of a prothrombin complex conjugate and its efficacy in rapidly correcting an elevated INR in these patients.


CONCLUSIONS
There is a need for well designed randomized clinical trials aimed at evaluating the efficacy of these agents in improving the outcome of patients with anticoagulant associated intracranial hemorrhage.
Aiyagari
Venkatesh
V
Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois 60612, USA. aiyagari@uic.edu
Testai
Fernando D
FD
D000925:Anticoagulants / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy; D004211:Disseminated Intravascular Coagulation; D015942:Factor VIIa / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006801:Humans; D010949:Plasma; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D014815:Vitamins / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014815:Vitamins; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin; D015942:Factor VIIa