title: The Role of FEIBA in Reversing Novel Oral Anticoagulants in Intracerebral Hemorrhage.
abstract: Activated prothrombin complex concentrates factor eight inhibitor bypassing activity (FEIBA) has been recommended for reversing novel oral anticoagulants (NOAC) in the context of intracerebral hemorrhage (ICH), though few clinical studies report its use.
  
  
  
  A prospective study of patients with spontaneous ICH was conducted from May 2013 to May 2015. Hospital complications including hemorrhage (gastrointestinal bleeding, anemia requiring transfusion, and surgical site bleeding) and thrombosis (pulmonary embolus, deep vein thrombosis, ischemic stroke, and myocardial infarction) were recorded. All ICH patients underwent baseline head CT and a follow-up stability scan in 6 h. NOAC taken within 48 h of presentation was reversed with FEIBA (50 u/kg) per protocol. Three-month outcomes were assessed using the modified rankin score (mRS).
  
  
  
  Of 127 ICH patients enrolled, 6 (5 %) had NOAC-related ICH including: oral factor XA inhibitor N = 5 (4 %; N = 4 rivaroxaban, N = 1 apixaban] and direct thrombin inhibitor N = 1 (0.8 %; dabigatran). The indication for NOAC was atrial fibrillation in all patients and the median CHADS2-VASC score was 4 (range 2-5). The median admission NIHSS was 2 (range 0-14) and the median ICH volume was 8 mL (range 1-20). Five patients (3 rivaroxaban, 1 apixaban, 1 dabigatran) presented within 48 h and received FEIBA within a median of 13 h (range 10-29 h) from their last NOAC dose and 8 h (range 4.5-20) from the time last known well. None of the patients had ICH expansion, hemorrhagic, or thrombotic complications. Three-month median mRS was 1 (range 0-6).
  
  
  
  In this small case series, reversal of NOAC with FEIBA was not associated with ICH expansion or any thrombotic or hemorrhagic complications.
authors.affiliation: Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Jamil R
authors.initials: JR
authors.lastname: Dibu
authors.affiliation: Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Weimer
authors.affiliation: Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Ahrens
authors.affiliation: Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Manno
authors.affiliation: Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA. frontej@ccf.org.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Frontera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000494:pharmacology*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D003029:Coagulants / Q000008:administration & dosage / Q000494:pharmacology*; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D012189:Retrospective Studies
chemical_list: D000991:Antithrombins; D001779:Blood Coagulation Factors; D003029:Coagulants; D065427:Factor Xa Inhibitors; C065655:anti-inhibitor coagulant complex
keywords: Activated prothrombin complex concentrate; Anticoagulant-related intracerebral hemorrhage reversal; Intracerebral hemorrhage; Novel oral anticoagulants