Critical Care: Heme and infection ICU |

Comparison of Long-term Functional Outcomes Following Treatment With and Without 4-Factor Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Hemorrhage FREE TO VIEW

Jennifer Cabot, MD; Matthew Coppola, MD; Michael Ganetsky; Nachiketa Gupta; Joshua Goldstein, MD; Louis Voigt, MD; Stephen Pastores, MD; Neil Halpern, MD; Haytham Kaafarani, MD; Kaushal Shah, MD; Jarone Lee, MD
Author and Funding Information

Memorial Sloan Kettering Cancer Center, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):284A. doi:10.1016/j.chest.2016.08.297
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SESSION TITLE: Heme and infection ICU

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 07:30 AM - 08:30 AM

PURPOSE: Data regarding the impact of 4-factor prothrombin complex concentrate (4F-PCC) on long-term functional outcomes following warfarin-associated intracranial hemorrhage (WICH) is lacking, despite known rapid international normalized ratio (INR) reversal.

METHODS: We conducted a retrospective matched cohort study of patients treated for WICH with or without 4F-PCC over a 48-month period from March 2011 to March 2015 at one tertiary care center. Subjects were matched on gender, age, initial INR, ICH type, ICH score, baseline modified Rankin Score (mRS), and baseline Barthel Index (BI). Adverse events (venous thromboembolism, myocardial infarction, pulmonary edema, rebleeding, and new bleeding), 1-week and 3-month mortality, 3-month mRS, and 3-month BI were compared between the groups using the Fisher’s exact test and 2-tail unpaired T-test.

RESULTS: A total of 43 patients were treated for WICH with 4F-PCC during the study period. Complete follow-up data was available for 30 patients. Of these, 25 (83%) were transferred from an outside hospital. The mean time from symptom onset to 4F-PCC administration was 16.5 hours (SD +/- 17) at a mean dose of 26 IU/kg (SD +/- 6). Eleven matched control patients were identified for comparison among those treated for WICH without 4F-PCC. The group of matched cases and controls (N=22) had the following characteristics: 73% male, 36% aged 80 years or older, and 100% with an initial INR of >1.5. ICH type included: 27% subdural hemorrhage, 27% intraparenchymal hemorrhage, and 46% mixed type. Median ICH score was 1 (IQR 0, 1), with 82% having a score 0-1. Median baseline mRS was 0 (IQR 0, 0) and median baseline BI was 20 (IQR 20, 20). One-week mortality was 9% in the 4F-PCC group vs. 0% in the control group (p = 1.00); three-month mortality was 36% vs. 18%, respectively (p = 0.64). Among the survivors in the 4F-PCC group, 29% had an increase of >1 point in 3-month mRS and 14% had a decrease of >2 points in 3-month BI, vs. 0% for both outcomes in the control group (p = 0.15 and 0.38, respectively). Four adverse events occurred in the 4F-PCC group vs. 1 in the control group (p = 0.31).

CONCLUSIONS: This study did not show a significant difference in mortality, long-term functional outcomes, or adverse events following treatment for WICH with and without 4F-PCC.

CLINICAL IMPLICATIONS: Our results suggest that 4F-PCC is not associated with an improvement in long-term functional outcomes if administered an average of 16.5 hours following WICH. Larger, prospective studies must be conducted to further investigate the utility and optimal timing of administration of 4F-PCC in this clinical scenario.

DISCLOSURE: The following authors have nothing to disclose: Jennifer Cabot, Matthew Coppola, Michael Ganetsky, Nachiketa Gupta, Joshua Goldstein, Louis Voigt, Stephen Pastores, Neil Halpern, Haytham Kaafarani, Kaushal Shah, Jarone Lee

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