Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

被引：77

作者：

Parry-Jones, Adrian R. ^{[1
,2
]}

Di Napoli, Mario ^{[3
,4
]}

Goldstein, Joshua N. ^{[5
]}

Schreuder, Floris H. B. M. ^{[6
]}

Tetri, Sami ^{[7
]}

Tatlisumak, Turgut ^{[8
]}

Yan, Bernard ^{[9
]}

van Nieuwenhuizen, Koen M. ^{[10
]}

Dequatre-Ponchelle, Nelly ^{[11
]}

Lee-Archer, Matthew ^{[12
]}

Horstmann, Solveig ^{[13
]}

Wilson, Duncan ^{[14
]}

Pomero, Fulvio ^{[15
]}

Masotti, Luca ^{[16
]}

Lerpiniere, Christine ^{[17
]}

Godoy, Daniel Agustin ^{[18
,19
]}

Cohen, Abigail S. ^{[20
]}

Houben, Rik ^{[6
]}

Al-Shahi Salman, Rustam ^{[17
]}

Pennati, Paolo ^{[16
]}

Fenoglio, Luigi ^{[15
]}

Werring, David ^{[14
]}

Veltkamp, Roland ^{[13
,21
]}

Wood, Edith ^{[2
]}

Dewey, Helen M. ^{[12
]}

Cordonnier, Charlotte ^{[11
]}

Klijn, Catharina J. M. ^{[10
]}

Meligeni, Fabrizio ^{[22
]}

Davis, Stephen M. ^{[9
,23
,24
]}

Huhtakangas, Juha ^{[7
]}

Staals, Julie ^{[6
]}

Rosand, Jonathan ^{[20
]}

Meretoja, Atte ^{[8
,9
,23
,24
]}

机构：

[1] Univ Manchester, Manchester Acad Hlth Sci Ctr, Salford Royal Natl Hlth Serv Fdn Trust, Salford, Lancs, England

[2] Salford Royal Natl Hlth Serv Fdn Trust, Greater Manchester Neurosci Ctr, Salford, Lancs, England

[3] San Camillo de Lellis Gen Hosp, Neurol Serv, Rieti, Italy

[4] Ctr Cardiovasc Med & Cerebrovasc Dis Prevent SMDN, Neurol Sect, Sulmona, Italy

[5] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA

[6] Maastricht Univ, Med Ctr, Dept Neurol, NL-6200 MD Maastricht, Netherlands

[7] Oulu Univ Hosp, Dept Neurol, Oulu, Finland

[8] Univ Helsinki, Cent Hosp, Dept Neurol, Helsinki, Finland

[9] Royal Melbourne Hosp, Dept Neurol, Parkville, Vic 3050, Australia

[10] Univ Med Ctr Utrecht, Rudolf Magnus Brain Ctr, Dept Neurol & Neurosurg, Utrecht, Netherlands

[11] Univ Lille Nord France UDSL, Dept Neurol, Lille Univ Hosp Ctr, Lille, France

[12] Austin Hosp, Dept Neurol, Heidelberg, Vic 3084, Australia

[13] Heidelberg Univ, Dept Neurol, Heidelberg, Germany

[14] UCL, London, England

[15] Santa Croce e Carle Hosp, Dept Internal Med, Cuneo, Italy

[16] Cecina Hosp, Internal Med, Cecina, Italy

[17] Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland

[18] Pasteur Sanat, Neurointens Care Unit, Catamarca, Argentina

[19] San Juan Bautista Hosp, Intens Care Unit, Catamarca, Argentina

[20] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA

[21] Univ London Imperial Coll Sci Technol & Med, Dept Med, London, England

[22] San Camillo de Lellis Gen Hosp, Dept Emergency Med, Rieti, Italy

[23] Univ Melbourne, Dept Med, Melbourne, Vic, Australia

[24] Univ Melbourne, Florey Inst, Melbourne, Vic, Australia

来源：

ANNALS OF NEUROLOGY | 2015年 / 78卷 / 01期

基金：

芬兰科学院; 英国医学研究理事会;

关键词：

PROTHROMBIN COMPLEX CONCENTRATE; FRESH-FROZEN PLASMA; ORAL ANTICOAGULANT; WARFARIN REVERSAL; HEMATOMA GROWTH; MANAGEMENT; EFFICACY; OUTCOMES; THERAPY; SAFETY;

D O I：

10.1002/ana.24416

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

ObjectiveThere is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. MethodsWe pooled individual ICH patient data from 16 stroke registries in 9 countries (n=10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio<1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. ResultsWe included 1,547 patients treated with FFP (n=377, 24%), PCC (n=585, 38%), both (n=131, 9%), or neither (n=454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%, HR=2.540, 95% confidence interval [CI]=1.784-3.616, p<0.001), followed by FFP alone (45.6%, HR=1.344, 95% CI=0.934-1.934, p=0.112), then PCC alone (37.3%, HR=1.445, 95% CI=1.014-2.058, p=0.041), compared to reversal with both FFP and PCC (27.8%, reference). Outcomes with PCC versus FFP were similar (HR=1.075, 95% CI=0.874-1.323, p=0.492); 4-factor PCC (n=441) was associated with higher case fatality compared to 3-factor PCC (n=144, HR=1.441, 95% CI=1.041-1.995, p=0.027). InterpretationThe combination of FFP and PCC might be associated with the lowest case fatality in reversal of VKA-ICH, and FFP may be equivalent to PCC. Randomized controlled trials with functional outcomes are needed to establish the most effective treatment. Ann Neurol 2015;78:54-62

引用

页码：54 / 62

页数：9

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