Original ArticleRecombinant Factor VIIa for Rapid Reversal of Warfarin Anticoagulation in Acute Intracranial Hemorrhage
Section snippets
PATIENTS AND METHODS
We reviewed the clinical, laboratory, and radiographic features of a consecutive series of 7 patients who had symptomatic, nontraumatic, warfarin-related acute ICH treated with rFVIIa at St. Luke's Hospital in Jacksonville, Fla, between December 2002 and September 2003. This study was approved by the Mayo Foundation Institutional Review Board.
Of the 7 patients in our study (mean age, 83.5 years; median age, 87 years; range, 70-92 years), 5 were women. Four patients had intraparenchymal
RESULTS
The median prestroke score on the modified Rankin Scale was zero (range, 0-2). Six patients were taking warfarin for chronic atrial fibrillation and 1 patient for deep venous thrombosis and pulmonary embolus. Five patients had a history of hypertension. No patient had a history of ischemic stroke, Alzheimer disease, or mild cognitive impairment. One patient had a history of carcinoma (prostate cancer status after radical prostatectomy with undetectable prostate-specific antigen). The mean INR
DISCUSSION
Factors that predict a worse outcome in ICH include hematoma volume, IVH, and a depressed level of consciousness.1 Early hemorrhage growth of more than 33% of baseline volume occurs within 24 hours in at least 38% of patients and is associated with neurologic deterioration.15 No surgical or medical intervention has been proved to reduce morbidity and mortality. Emergent hematoma evacuation (within the first 3-4 hours) is often delayed by standard anticoagulation reversal methods, thereby
CONCLUSIONS
Compared with conventional treatment with FFP and vitamin K, intravenous bolus administration of rFVIIa clearly leads to rapid correction of the INR in patients taking warfarin without risk of hypervolemia and anaphylaxis. Thus, rFVIIa can expedite safe neurosurgical hematoma evacuation. What is less clear is whether emergent use of rFVIIa can improve neurologic and functional outcomes with or without hematoma evacuation. The therapeutic time window for rapid warfarin reversal is also unclear
Acknowledgments
We thank Darlene E. Gunsolus for her assistance with the preparation of the submitted manuscript.
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Presented in part at the 29th International Stroke Conference, San Diego, Calif, February 5 to 7, 2004.
Dr Brott has served on the Data and Safety Monitoring Board of a randomized clinical trial sponsored by Novo Nordisk (Princeton, NJ) of recombinant factor VIIa (NovoSeven) for spontaneous intracerebral hemorrhage.