Abstract

INTRACRANIAL HEMORRHAGE WHILE ON WARFARIN: MANAGEMENT PRINCIPLES

Ozgur Karcioglu*, Selman Yeniocak, Suleyman Alpar, Bilgen Ozkaya, Mandana Hosseinzadeh and Banu Karakus Yilmaz

Abstract

Introduction: Physicians prescribe vitamin K antagonists (VKA) with many different indications to induce coagulopathy which protect the patients from thrombotic processes and embolism thereof. On the other hand, these agents are not innocent and a substantial number of patients experience serious bleeding. This article is a review and critical analysis of the recent literature to analyse treatment with the agents used to treat intracranial hemorrhage (ICH) in patients on treatment with warfarin. Methods: Currently available literature on the use of vitamin K, fresh frozen plasma (FFP), prothrombin complex concentrates (PCC) in ICH was identified by searches of available databases. Usage of these agents was addressed in the literature data found by searches of databases. The indications, efficacy and outcomes associated with the use of PCC (3 vs 4-factors) were abstracted from the manuscripts. Results: VKA–induced ICH represents a challenge for the healthcare system with a high mortality rate and long-term socioeconomical burden. Comparisons of results following treatment with PCC and vitamin K, Fresh frozen plasma (FFP) are summarized. PCC appears to be the first-line treatment for reduction of prothrombin time and INR values to normal limits and restoration of hemodynamic status in patients with VKA-ICH. Dosing rules are also discussed. Conclusion: VKA–ICH can be viewed as a catastrophic event in the vulnerable group of anticoagulated patients. Although many reasonable options are available, PCC in conjunction with vitamin K administration appear to be the most fruitful strategy for resuscitation in VKA-ICH associated with high INR values. Adverse and untoward effects of the agents do not outweigh the benefits of usage in patients with VKA-ICH.

Keywords: Prothrombin complex concentrates; vitamin K antagonists; warfarin; coagulopathy; intracranial hemorrhage.