TY - JOUR
T1 - Timing of INR reversal using fresh-frozen plasma in warfarin-associated intracerebral hemorrhage
AU - Akhter, Murtaza
AU - Morotti, Andrea
AU - Cohen, Abigail Sara
AU - Chang, Yuchiao
AU - Ayres, Alison M.
AU - Schwab, Kristin
AU - Viswanathan, Anand
AU - Gurol, Mahmut Edip
AU - Anderson, Christopher David
AU - Greenberg, Steven Mark
AU - Rosand, Jonathan
AU - Goldstein, Joshua Norkin
N1 - Funding Information:
Funding This study was funded by support from NIH NINDS K23NS086873, NIH NINDS K23AG02872605, NIH NINDS 5R01NS073344, and NIH NINDS R01NS059727.
Publisher Copyright:
© 2017, SIMI.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Rapid reversal of coagulopathy is recommended in warfarin-associated intracerebral hemorrhage (WAICH). However, rapid correction of the INR has not yet been proven to improve clinical outcomes, and the rate of correction with fresh-frozen plasma (FFP) can be variable. We sought to determine whether faster INR reversal with FFP is associated with decreased hematoma expansion and improved outcome. We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with WAICH presenting to an urban tertiary care hospital from 2000 to 2013. Patients with baseline INR > 1.4 treated with FFP and vitamin K were included. The primary outcomes are occurrence of hematoma expansion, discharge modified Rankin Scale (mRS), and 30-day mortality. The association between timing of INR reversal, ICH expansion, and outcome was investigated with logistic regression analysis. 120 subjects met inclusion criteria (mean age 76.9, 57.5% males). Median presenting INR was 2.8 (IQR 2.3–3.4). Hematoma expansion is not associated with slower INR reversal [median time to INR reversal 9 (IQR 5–14) h vs. 10 (IQR 7–16) h, p = 0.61]. Patients with ultimately poor outcome received more rapid INR reversal than those with favorable outcome [9 (IQR 6–14) h vs. 12 (8–19) h, p = 0.064). We find no evidence of an association between faster INR reversal and either reduced hematoma expansion or better outcome.
AB - Rapid reversal of coagulopathy is recommended in warfarin-associated intracerebral hemorrhage (WAICH). However, rapid correction of the INR has not yet been proven to improve clinical outcomes, and the rate of correction with fresh-frozen plasma (FFP) can be variable. We sought to determine whether faster INR reversal with FFP is associated with decreased hematoma expansion and improved outcome. We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with WAICH presenting to an urban tertiary care hospital from 2000 to 2013. Patients with baseline INR > 1.4 treated with FFP and vitamin K were included. The primary outcomes are occurrence of hematoma expansion, discharge modified Rankin Scale (mRS), and 30-day mortality. The association between timing of INR reversal, ICH expansion, and outcome was investigated with logistic regression analysis. 120 subjects met inclusion criteria (mean age 76.9, 57.5% males). Median presenting INR was 2.8 (IQR 2.3–3.4). Hematoma expansion is not associated with slower INR reversal [median time to INR reversal 9 (IQR 5–14) h vs. 10 (IQR 7–16) h, p = 0.61]. Patients with ultimately poor outcome received more rapid INR reversal than those with favorable outcome [9 (IQR 6–14) h vs. 12 (8–19) h, p = 0.064). We find no evidence of an association between faster INR reversal and either reduced hematoma expansion or better outcome.
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U2 - 10.1007/s11739-017-1680-2
DO - 10.1007/s11739-017-1680-2
M3 - Article
C2 - 28573379
AN - SCOPUS:85020057205
SN - 1828-0447
VL - 13
SP - 557
EP - 565
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 4
ER -