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International Journal of Emergency Medicine

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Open Access 01-12-2011 | Review

Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: a structured literature review

Authors: Brett F Bechtel, Timothy C Nunez, Jennifer A Lyon, Bryan A Cotton, Tyler W Barrett

Published in: International Journal of Emergency Medicine | Issue 1/2011

Abstract

Study objective

The acute management of patients on warfarin with spontaneous or traumatic intracranial hemorrhage continues to be debated in the medical literature. The objective of this paper was to conduct a structured review of the medical literature and summarize the advantages and risks of the available treatment options for reversing warfarin anticoagulation in patients who present to the emergency department with acute intracranial hemorrhage.

Methods

A structured literature search and review of articles relevant to intracranial hemorrhage and warfarin and treatment in the emergency department was performed. Databases for PubMed, CINAHL, and Cochrane EBM Reviews were electronically searched using keywords covering the concepts of anticoagulation drugs, intracranial hemorrhage (ICH), and treatment. The results generated by the search were limited to English- language articles and reviewed for relevance to our topic. The multiple database searches revealed 586 papers for review for possible inclusion. The final consensus of our comprehensive search strategy was a total of 23 original studies for inclusion in our review.

Results

Warfarin not only increases the risk of but also the severity of ICH by causing hematoma expansion. Prothrombin complex concentrate is statistically significantly faster at correcting the INR compared to fresh frozen plasma transfusions. Recombinant factor VIIa appears to rapidly reverse warfarin's effect on INR; however, this treatment is not FDA-approved and is associated with a 5% thromboembolic event rate. Slow intravenous dosing of vitamin K is recommended in patients with ICH. The 30-day risk for ischemic stroke after discontinuation of warfarin therapy was 3-5%. The risks of not reversing the anticoagulation in ICH generally outweigh the risk of thrombosis in the acute setting.

Conclusions

Increasing numbers of patients are on anticoagulation including warfarin. There is no uniform standard for reversing warfarin in intracranial hemorrhage. Intravenous vitamin K in addition to fresh frozen plasma or prothrombin complex concentrate is recommended be used to reverse warfarin-associated intracranial hemorrhage. No mortality benefit for one treatment regimen over another has been shown. Emergency physicians should know their hospital's available warfarin reversal options and be comfortable administering these treatments to critically ill patients.

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Title: Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: a structured literature review
Authors: Brett F Bechtel
Timothy C Nunez
Jennifer A Lyon
Bryan A Cotton
Tyler W Barrett
Publication date: 01-12-2011
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Emergency Medicine / Issue 1/2011
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/1865-1380-4-40

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: a structured literature review

Abstract

Study objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Study objective

Methods

Results

Conclusions

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