Warfarin-related intracerebral haemorrhage: better outcomes when reversal includes prothrombin complex concentrates

摘要: Background Warfarin-related intracerebral haemorrhage (WRICH) has high mortality. Haematoma expansion is prolonged in WRICH and independently predicts worse outcomes. Guidelines recommend prompt reversal of the warfarin coagulopathy, but evidence benefit lacking. Aims To determine whether introduction a protocol (late 2008), which includes prothrombin complex concentrates (PCC), improves outcomes Methods All patients presenting with between January 2004 July 2010 were included. Retrospective case note radiology review was performed, collecting data on (ICH) severity, degree timeliness reversal, patient Cox's proportional hazards analysis used to compare outcomes associated without PCC after controlling for ICH severity. Results Eighty-eight included (27 treated palliatively). Mean international normalised ratio 2.9. Vitamin K, fresh frozen plasma given alone or combination 68, 23 44 patients, mean time from computed tomography scanning administration 2.2, 3.3 3.1 h respectively. Four received pre-protocol (none before 2007), two during development seventeen post-protocol. Those who had improved survival (P < 0.001). After score, hazard death 0.27 0.01) use PCC. Survival tended be greater earlier = 0.053). Despite survival, discharge domicile function not significantly worse. Conclusions PCC worsened disability. Delays may have reduced potential benefits.