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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Prothrombin complex concentrate for coumadin anticoagulation reversal in traumatic intracranial haemorrhage

Meeting Abstract

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  • Christopher Beynon - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Mohammed Nofal - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Mona Laible - Universitätsklinikum Heidelberg, Neurologische Klinik, Heidelberg, Deutschland
  • Timolaos Rizos - Universitätsklinikum Heidelberg, Neurologische Klinik, Heidelberg, Deutschland
  • Anna Potzy - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Andreas Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.01.04

doi: 10.3205/17dgnc004, urn:nbn:de:0183-17dgnc0042

Published: June 9, 2017

© 2017 Beynon et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Several guidelines recommend administration of prothrombin complex concentrate (PCC) for anticoagulation reversal in cases of severe bleeding. However, there is only limited data on its use for anticoagulation reversal in anticoagulated patients with traumatic intracranial haemorrhage (tICH). Here we present our experiences with PCC administration for rapid anticoagulation reversal in these patients.

Methods: We retrospectively analysed our institutional database of patients receiving PCC between 2005 and 2014 (n>1000). Data from anticoagulated patients (vitamin k antagonists) referred to our hospital for treatment of tICH and who received PCC for anticoagulation reversal were included in this analysis. Patient characteristics as well as treatment modalities were analysed with specific focus on results of laboratory examination, modalities of PCC administration and neurosurgical procedures as well as bleeding / thromboembolic complications during the further course.

Results: A total of 101 patients were included in this analysis. The median age was 78 years and the median GCS score on admission was 12 (Interquartile range [IQR]: 7-14). Computed tomography had evidence of subdural haematoma in 65 patients and traumatic intracerebral/subarachnoid haemorrhage in 64 patients. Median INR on admission was 2.56 [IQR: 2.1-3.6] and decreased to 1.20 [IQR: 1.13-1.3] following administration of a median dose of 2000 I.U. PCC [IQR: 1500-2750]. Neurosurgical procedures were carried out in 55 patients (55%). The in-hospital mortality rate was 14% and median GCS of survivors at discharge was 14 [IQR: 13-15]. There were no thromboembolic events during the further course of patients.

Conclusion: PCC administration rapidly normalises INR and facilitates urgent neurosurgical procedures in anticoagulated patients with tICH. The risk of thromboembolic events is low and justifies the use of PCC for anticoagulation reversal in light of this potentially life-threatening condition.