Prothrombin complex concentrate for vitamin K antagonist reversal in traumatic intracranial hemorrhage

Beynon, Christopher; Nofal, Mohammed; Rizos, Timolaos; Laible, Mona; Sakowitz, Oliver W.; Unterberg, Andreas

doi:10.1016/j.jocn.2020.07.006

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…The usefulness of PCC has been demonstrated, with evidence of reduced haematoma formation in patients with head injury [ 295 ], and is preferable to FFP for the rapid reversal of the effects of vitamin K antagonists (VKAs) [ 296 ] (see recommendation R33). In a recent meta-analysis comparing the treatment of patients with trauma-induced coagulopathy with FFP alone vs. FFP plus PCC, the addition of PCC was found to decrease the transfusion of pRBC and FFP and to decrease mortality significantly without increasing thromboembolic adverse events [ 297 ].…”

Section: Resultsmentioning

confidence: 99%

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The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

“…There are three therapeutic options for the reversal of VKAs: vitamin K, PCC and FFP. Modern guidelines advise the rapid restoration of a normal INR, although evidence that this improves clinical outcome is limited to case series [ 295 , 334 – 338 ], one suggesting more improvement if PCC was administered rapidly [ 337 ].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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“…However, acute reversal strategies are available for some but not all oral anticoagulation drugs as well as antiplatelet agents [ 7 , 51 ]. Prothrombin complex concentrate (PCC) therapy is shown to be effective in the rapid lowering of INR in the case of traumatic coagulopathy in patients with or without the pre-injury use of warfarin [ 2 , 18 ]. The use of PCC therapy can quickly facilitate neurosurgical care of anticoagulated patients with ICH [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prothrombin complex concentrate (PCC) therapy is shown to be effective in the rapid lowering of INR in the case of traumatic coagulopathy in patients with or without the pre-injury use of warfarin [ 2 , 18 ]. The use of PCC therapy can quickly facilitate neurosurgical care of anticoagulated patients with ICH [ 2 ]. It is also shown that treatment with recombinant activated factor VII rapidly after the onset of ICH can reduce the growth of the hematoma [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Craniotomies following acute traumatic brain injury in Finland—a national study between 1997 and 2018

et al. 2022

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Background A number of patients who sustain a traumatic brain injury (TBI) require surgical intervention due to acute intracranial bleeding. The aim of this retrospective study was to assess the national trends of acute craniotomies following TBI in the Finnish adult population. Methods The data were collected retrospectively from the Finnish Care Register for Health Care (1997–2018). The study cohort covered all first-time registered craniotomies following TBI in patients aged 18 years or older. A total of 7627 patients (median age = 59 years, men = 72%) were identified. Results The total annual incidence of acute trauma craniotomies decreased by 33%, from 8.6/100,000 in 1997 to 5.7/100,000 in 2018. The decrease was seen in both genders and all age groups, as well as all operation subgroups (subdural hematoma, SDH; epidural hematoma, EDH; intracerebral hematoma, ICH). The greatest incidence rate of 15.4/100,000 was found in patients 70 years or older requiring an acute trauma craniotomy. The majority of surgeries were due to an acute SDH and the patients were more often men. The difference between genders decreased with age (18–39 years = 84% men, 40–69 = 78% men, 70 + years = 55% men). The median age of the patients increased from 58 to 65 years during the 22-year study period. Conclusions The number of trauma craniotomies is gradually decreasing; nonetheless, the incidence of TBI-related craniotomies remains high among geriatric patients. Further studies are needed to determine the indications and derive evidence-based guidelines for the neurosurgical care of older adults with TBIs to meet the challenges of the growing elderly population.

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Systematic review on traumatic intracranial haemorrhage in patients on anti-thrombotic medications; haemorrhage progression, thrombosis, and anti-thrombotic recommencement

2023

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Prothrombin complex concentrate for vitamin K antagonist reversal in traumatic intracranial hemorrhage

Cited by 6 publications

References 26 publications

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Craniotomies following acute traumatic brain injury in Finland—a national study between 1997 and 2018

Systematic review on traumatic intracranial haemorrhage in patients on anti-thrombotic medications; haemorrhage progression, thrombosis, and anti-thrombotic recommencement

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