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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...

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Autores principales: 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
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
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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
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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
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