Cargando…
Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage
OBJECTIVE: There 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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654243/ https://www.ncbi.nlm.nih.gov/pubmed/25857223 http://dx.doi.org/10.1002/ana.24416 |
_version_ | 1782402027993694208 |
---|---|
author | Parry‐Jones, Adrian R. Di Napoli, Mario Goldstein, Joshua N. Schreuder, Floris H. B. M. Tetri, Sami Tatlisumak, Turgut Yan, Bernard van Nieuwenhuizen, Koen M. Dequatre‐Ponchelle, Nelly Lee‐Archer, Matthew Horstmann, Solveig Wilson, Duncan Pomero, Fulvio Masotti, Luca Lerpiniere, Christine Godoy, Daniel Agustin Cohen, Abigail S. Houben, Rik Al‐Shahi Salman, Rustam Pennati, Paolo Fenoglio, Luigi Werring, David Veltkamp, Roland Wood, Edith Dewey, Helen M. Cordonnier, Charlotte Klijn, Catharina J. M. Meligeni, Fabrizio Davis, Stephen M. Huhtakangas, Juha Staals, Julie Rosand, Jonathan Meretoja, Atte |
author_facet | Parry‐Jones, Adrian R. Di Napoli, Mario Goldstein, Joshua N. Schreuder, Floris H. B. M. Tetri, Sami Tatlisumak, Turgut Yan, Bernard van Nieuwenhuizen, Koen M. Dequatre‐Ponchelle, Nelly Lee‐Archer, Matthew Horstmann, Solveig Wilson, Duncan Pomero, Fulvio Masotti, Luca Lerpiniere, Christine Godoy, Daniel Agustin Cohen, Abigail S. Houben, Rik Al‐Shahi Salman, Rustam Pennati, Paolo Fenoglio, Luigi Werring, David Veltkamp, Roland Wood, Edith Dewey, Helen M. Cordonnier, Charlotte Klijn, Catharina J. M. Meligeni, Fabrizio Davis, Stephen M. Huhtakangas, Juha Staals, Julie Rosand, Jonathan Meretoja, Atte |
author_sort | Parry‐Jones, Adrian R. |
collection | PubMed |
description | OBJECTIVE: There 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. METHODS: We 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. RESULTS: We 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). INTERPRETATION: The 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 |
format | Online Article Text |
id | pubmed-4654243 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-46542432015-11-27 Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage Parry‐Jones, Adrian R. Di Napoli, Mario Goldstein, Joshua N. Schreuder, Floris H. B. M. Tetri, Sami Tatlisumak, Turgut Yan, Bernard van Nieuwenhuizen, Koen M. Dequatre‐Ponchelle, Nelly Lee‐Archer, Matthew Horstmann, Solveig Wilson, Duncan Pomero, Fulvio Masotti, Luca Lerpiniere, Christine Godoy, Daniel Agustin Cohen, Abigail S. Houben, Rik Al‐Shahi Salman, Rustam Pennati, Paolo Fenoglio, Luigi Werring, David Veltkamp, Roland Wood, Edith Dewey, Helen M. Cordonnier, Charlotte Klijn, Catharina J. M. Meligeni, Fabrizio Davis, Stephen M. Huhtakangas, Juha Staals, Julie Rosand, Jonathan Meretoja, Atte Ann Neurol Research Articles OBJECTIVE: There 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. METHODS: We 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. RESULTS: We 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). INTERPRETATION: The 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 John Wiley and Sons Inc. 2015-07 2015-05-14 /pmc/articles/PMC4654243/ /pubmed/25857223 http://dx.doi.org/10.1002/ana.24416 Text en © 2015 The Authors Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Articles Parry‐Jones, Adrian R. Di Napoli, Mario Goldstein, Joshua N. Schreuder, Floris H. B. M. Tetri, Sami Tatlisumak, Turgut Yan, Bernard van Nieuwenhuizen, Koen M. Dequatre‐Ponchelle, Nelly Lee‐Archer, Matthew Horstmann, Solveig Wilson, Duncan Pomero, Fulvio Masotti, Luca Lerpiniere, Christine Godoy, Daniel Agustin Cohen, Abigail S. Houben, Rik Al‐Shahi Salman, Rustam Pennati, Paolo Fenoglio, Luigi Werring, David Veltkamp, Roland Wood, Edith Dewey, Helen M. Cordonnier, Charlotte Klijn, Catharina J. M. Meligeni, Fabrizio Davis, Stephen M. Huhtakangas, Juha Staals, Julie Rosand, Jonathan Meretoja, Atte Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage |
title | Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage |
title_full | Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage |
title_fullStr | Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage |
title_full_unstemmed | Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage |
title_short | Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage |
title_sort | reversal strategies for vitamin k antagonists in acute intracerebral hemorrhage |
topic | Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654243/ https://www.ncbi.nlm.nih.gov/pubmed/25857223 http://dx.doi.org/10.1002/ana.24416 |
work_keys_str_mv | AT parryjonesadrianr reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT dinapolimario reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT goldsteinjoshuan reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT schreuderflorishbm reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT tetrisami reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT tatlisumakturgut reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT yanbernard reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT vannieuwenhuizenkoenm reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT dequatreponchellenelly reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT leearchermatthew reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT horstmannsolveig reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT wilsonduncan reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT pomerofulvio reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT masottiluca reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT lerpinierechristine reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT godoydanielagustin reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT cohenabigails reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT houbenrik reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT alshahisalmanrustam reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT pennatipaolo reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT fenoglioluigi reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT werringdavid reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT veltkamproland reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT woodedith reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT deweyhelenm reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT cordonniercharlotte reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT klijncatharinajm reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT meligenifabrizio reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT davisstephenm reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT huhtakangasjuha reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT staalsjulie reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT rosandjonathan reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage AT meretojaatte reversalstrategiesforvitaminkantagonistsinacuteintracerebralhemorrhage |