title: Coagulation factor VIIa (recombinant) for warfarin-induced intracranial hemorrhage.
abstract: OBJECTIVE
  The use of coagulation factor VIIa (recombinant) for the treatment of warfarin-induced intracranial hemorrhage (ICH) is described.
  
  
  CONCLUSIONS
  ICH is a devastating disorder that can be exacerbated by the use of oral anticoagulation. The treatment of warfarin-associated ICH involves the prompt reversal of anticoagulation to allow for surgical procedures, if necessary. Despite limited labeled indications, factor VIIa (recombinant) has been used to reverse warfarin-induced anticoagulation in patients with active hemorrhage, partly due to the rapid effect of factor VIIa on the International Normalized Ratio and the ability to administer the drug quickly in acute settings. The efficacy of factor VIIa (recombinant) for the reversal of anticoagulation in patients with warfarin-associated ICH has been described in several case reports, case series, and retrospective cohort studies. Based on these reports, the use of factor VIIa (recombinant) for the treatment of warfarin-associated ICH may be a viable alternative or adjunct therapy to standard treatment with fresh-frozen plasma and vitamin K. However, due to the nature of these reports, future controlled trials should be conducted to verify the exact place for factor VIIa (recombinant) for this indication. Thromboembolic complications are rare but serious complications secondary to the use of factor VIIa (recombinant). Though differences exist in the reported rate of thromboembolic complications associated with factor VIIa (recombinant), factor VIIa (recombinant) should be used with caution in patients with a predisposition to thromboembolic complications.
  
  
  CONCLUSIONS
  Use of factor VIIa (recombinant) may be considered for reversal of anticoagulation in patients with warfarin-associated ICH. However, patients should be screened for increased risk of thrombosis before administration of the drug.
authors.affiliation: Department of Pharmacy, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37920, USA. arowe@utmck.edu
authors.forename: A Shaun
authors.initials: AS
authors.lastname: Rowe
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Turner
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D015942:Factor VIIa / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000139:chemically induced; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D011994:Recombinant Proteins; D014859:Warfarin; D015942:Factor VIIa