Morning Report: 5/31/2012

Thank you to Dr. Pearsall for today’s Morning Report:

Reversing coumadin-associated ICH: PCC vs FFP

Vitamin K for sustained reversal of vit-K dependent coag factors (10mg IV slowly)

Oral anticoagulant therapy increases degree of bleeding, with mortality > 50%

PCC: inactive vit-K dependent coag factors (II, IX, X & variable amts of VII)

Two available products in US largely 3-factor, containing little or no VII
European preparations contain all four; most studies look at products with all four

PCC vs FFP

Typically requires < 200mL vs FFP (up to 3 liters); avoids fluid overload

Dose immediately; no need to wait for thawing or ABO matching

Lower risk of viral transmission, TRALI, anaphylactoid rxn

Corrects within 10-30 minutes to an INR level significantly lower than FFP (INR of FFP is approx 1.5)

Decrease in hematoma expansion, reduced M&M

Reversal of anticoagulation increases risk of thrombotic events: venous & arterial

Huttner et al. Hematoma growth and outcome in treated neurocritical care pts with ICH related to OAT: comparison of acute treatment strategies using vit K, FFP & PCC. Stroke 2006;37(6):1465-70.

Bechtel et al. Treatments for reversing warfarin anticoagulation in pts with acute ICH: a structured literature review. Int J Emerg Med. 2011;4:40.

Makris et al. Emergency oral anticoagulant reversal: the relative efficacy of infusions of FFP & clotting factor concentrate on correction of the coagulopathy. Throb Haemostasis 1997;77:477-480.