title: Treatment With Prothrombin Complex Concentrate to Enable Emergency Lumbar Puncture in Patients Receiving Vitamin K Antagonists.
abstract: Lumbar punctures are frequently necessary in neurologic emergencies, but effective oral anticoagulation with vitamin K antagonists represents a contraindication. We report the effectiveness of prothrombin complex concentrates to reverse vitamin K antagonist to enable emergency lumbar punctures, as well as evaluate lumbar puncture- and prothrombin complex concentrates-related complications.
  
  
  
  Consecutive patients treated with prothrombin complex concentrates between December 2004 and June 2014 to enable emergency lumbar puncture were included. International normalized ratio (INR) before and after prothrombin complex concentrates treatment and the time between start of reversal treatment and lumbar puncture were recorded. A target INR of less than or equal to 1.5 was defined as effective prothrombin complex concentrates treatment. Bleeding events, thromboembolic events, and allergic reactions after prothrombin complex concentrates treatment were identified and classified as "related," "probably," "possibly," "unlikely related," or "not related" to the lumbar puncture and prothrombin complex concentrates infusion.
  
  
  
  Thirty-seven patients were included (64.9% men; median age 76.0 years; interquartile range [IQR] 71.0 to 84.0 years). The intervention with prothrombin complex concentrates was effective in 33 of 37 patients (89.2%; 95% confidence interval [CI], 78.4% to 97.3%). The median INR was 2.2 (IQR 1.8 to 2.9; 95% CI, 1.9 to 2.5) before and 1.3 (IQR 1.2 to 1.4; 95% CI, 1.2 to 1.3) after prothrombin complex concentrates treatment. The median time between start of prothrombin complex concentrates treatment and lumbar puncture was 135 minutes (IQR 76 to 266 minutes; 95% CI, 84 to 198 minutes). One clinically irrelevant intracranial subdural hematoma "related" to the lumbar puncture developed. No allergic reaction was observed, but 2 of 37 patients (5.4%; 95% CI, 0% to 13.5%) experienced a thromboembolic event (1 ischemic stroke, classified "unlikely related," and 1 myocardial infarction, "possibly related" to prothrombin complex concentrates treatment).
  
  
  
  Reversing the effect of vitamin K antagonist with prothrombin complex concentrates to enable emergency lumbar puncture appears effective and safe, particularly in regard to bleeding events.
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Mona
authors.initials: M
authors.lastname: Laible
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Beynon
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany; Department of Cerebrovascular diseases, Hetzelstift, Neustadt an der Weinstrasse, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Sander
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Purrucker
authors.affiliation: Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany; German Center for Cardiovascular Research, partner site Heidelberg/Mannheim, Heidelberg, Germany.
authors.forename: Oliver Josef
authors.initials: OJ
authors.lastname: Müller
authors.affiliation: Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Möhlenbruch
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Peter Arthur
authors.initials: PA
authors.lastname: Ringleb
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: timolaos.rizos@med.uni-heidelberg.de.
authors.forename: Timolaos
authors.initials: T
authors.lastname: Rizos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000379:methods*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates