Effect of prothrombin complex concentrate on hematoma enlargement and clinical outcome in patients with anticoagulant-associated intracerebral hemorrhage.
BACKGROUND
The present study was carried out to determine the effect of prothrombin complex concentrate (PCC) on hematoma enlargement (HE) and the early clinical outcome of intracerebral hemorrhage (ICH) patients on long-term warfarin treatment.


METHODS
The medical records and computed tomography (CT) images of 50 consecutive ICH patients on long-term warfarin treatment (35 men, 15 women; 69 ± 12 years old) were reviewed. International normalized ratio (INR) values, frequency of HE and clinical outcome were compared between patients treated with and without PCC.


RESULTS
INR values on admission were above 2.0 in 37 patients, of whom 19 were given PCC (PCC group) and 18 were not given PCC (control group). In these 37 patients, the frequency of HE (p = 0.017), the number of patients with a poor clinical outcome (modified Rankin Scale score ≥3 at 30 days or at discharge; p = 0.045) and in-hospital mortality (p = 0.042) were significantly higher in the control than in the PCC group. On multivariate logistic regression analysis with adjustment, PCC administration was independently associated (odds ratio 0.03, 95% confidence interval 0.00-0.63; p = 0.023) with a reduction in poor clinical outcome in ICH patients whose INR values were >2.0 on admission.


CONCLUSIONS
Immediate INR reversal with PCC may prevent HE and subsequent poor outcome.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. tkuwashi@intmed2.med.kyushu-u.ac.jp
Takahiro
T
Kuwashiro
Masahiro
M
Yasaka
Ryo
R
Itabashi
Hideaki
H
Nakagaki
Fumio
F
Miyashita
Hiroaki
H
Naritomi
Kazuo
K
Minematsu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D016009:Chi-Square Distribution; D003029:Coagulants / Q000627:therapeutic use*; D005260:Female; D006406:Hematoma / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D019934:International Normalized Ratio; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects*; D055815:Young Adult
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D003029:Coagulants; C025667:prothrombin complex concentrates; D014859:Warfarin