Rapid Anticoagulation Reversal With Prothrombin Complex Concentrate Before Emergency Brain Tumor Surgery

Beynon, Christopher; Potzy, Anna; Jungk, Christine; Unterberg, Andreas; Sakowitz, Oliver W.

doi:10.1097/ana.0000000000000104

Cited by 7 publications

(5 citation statements)

References 31 publications

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“…Nevertheless, the mortality rate was high, and outcomes were poor, in patients with warfarin-associated coagulopathy, and were mainly attributed to greater disease severity. Our findings contribute to the growing literature showing that the PCC facilitates neurosurgical intervention in patients taking VKAs and requiring urgent neurosurgical intervention, and is associated with acceptable safety and efficacy [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

Section: Discussionsupporting

confidence: 62%

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

et al. 2018

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Objective: The number of patients presenting with warfarin-associated intracranial bleeding and needing neurosurgical intervention is growing. Prothrombin complex concentrate (PCC) is commonly used for anti-coagulation reversal before emergent surgery. We present our experience with PCC use in patients presenting with coagulopathy and needing urgent craniotomy. Methods: We retrospectively identified all patients presenting with intracranial bleeding and coagulopathy due to warfarin use, requiring urgent neurosurgical procedures, from January, 2014 (implementation of 4-PCC therapy) until December, 2016. For coagulation reversal, all patients received 4-PCC (Octaplex) and vitamin K. Results: Thirty-five consecutive patients (17 men; median age 72 years) were administered 4-PCC before emergent neurosurgical procedures. The majority of patients presented with traumatic subdural hematoma (62%) and spontaneous intracerebral hemorrhage (32%). All patients were taking warfarin. Median international normalized ratio (INR) on admission was 2.94 (range: 1.20 to 8.60). Median 4-PCC dose was 2000 I.U. (range: 500 I.U. to 3000 I.U.). There was a statically significant decrease in INR (p < 0.01), PT (p < 0.01), and PTT (p = 0.02) after 4-PCC administration. Postoperative INR values were ≤3.00 in all patients, and seven (20%) patients had normal INR values. There were no 4-PCC related complications. Four (11%) patients developed subdural/epidural hematoma and 20 (57%) patients died. Mortality was associated with lower Glasgow coma scale (GCS) score. Conclusions: The 4-PCC facilitates INR reversal and surgery in patients presenting with warfarin-associated coagulopathy and intracranial bleeding requiring urgent neurosurgical intervention.

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Section: Discussionsupporting

confidence: 62%

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

et al. 2018

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“…Computer simulation teaching combined with PBL can cultivate students' comprehensive quality, deepen their knowledge and understanding of the original theoretical knowledge in textbooks, and train both comprehensive analysis ability and knowledge application ability, so that students can really become the discoverer and applicator of knowledge and improve their comprehensive quality. In the specific computer simulation scenario, students can exercise their teamwork and social practice [23]. e students develop practical skills and good psychological quality.…”

Section: Discussionmentioning

confidence: 99%

Application of Computer-Based Simulation Teaching Combined with PBL in Colorectal Tumor Hemorrhage

Zhang

Zhao

2022

Emergency Medicine International

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Objective. This paper aims to explore the use of computer-based simulation teaching combined with PBL in colorectal tumor bleeding. Methods. The outpatient department organized 21 nursing staffs to conduct computer simulation combined with PBL teaching, compared emergency theory and skill scores, and investigated the recognition of computer simulation teaching combined with PBL. Results. The scores of theoretical knowledge examination before training were (84.31 ± 6.39) and (92.59 ± 2.93) after training; the scores of treatment skills examination were (85.69 ± 6.15) and (95.43 ± 2.88) after training; the scores of comprehensive treatment skills before training were (76.6 ± 6.31) and (91.43 ± 2.3) after training. The results of the questionnaires showed that the nurses were more agreeable to the new teaching methods and were able to complete the tasks in strict accordance with the requirements, ultimately achieving a level of satisfaction with their progress. Conclusion. Computer simulation teaching combined with PBL can deepen general practitioners’ understanding of knowledge, improve practical ability, and provide a clinical basis for improving patient resuscitation in specialized oncology hospitals.

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“…16,24 In patients requiring more extensive surgery (e.g., heart transplantation, neurosurgery), this time period ranged from 2.5–5.2 hours. 22,23,36…”

Section: Resultsmentioning

confidence: 99%

“…All-cause mortality rates were generally between 10% and 25%, 14,22,23,30,37 although one study in patients requiring neurosurgery due to a life-threatening intracranial hemorrhage reported a mortality rate of 43.5%. 21 It should be noted that this study included high-risk patients with serious head trauma; the authors also highlighted that delays in therapy administration, subtherapeutic doses of prothrombin complex concentrate and incorrect vitamin K use may also have been factors contributing to this high mortality rate.…”

Section: Resultsmentioning

confidence: 99%

“…In the studies identified in our search, rates of venous thromboembolic events in patients receiving prothrombin complex concentrates varied considerably from 0% to 26.3%. 19,22,23,25,31,37,41,64,81–83 We also identified two case studies which each reported a patient undergoing surgery who developed a venous thromboembolic event within 1 hour following 3 factor- prothrombin complex concentrate administration. 35,84 It should be noted that many of these studies included few patients and the patient populations investigated often had a number of comorbidities; moreover, once vitamin K antagonist therapy is reversed, the underlying risk that first necessitated anticoagulation is restored, and as a result, caution should be taken when interpreting these findings.…”

Section: Resultsmentioning

confidence: 99%

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Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal

et al. 2018

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Vitamin K antagonist therapy is associated with an increased bleeding risk, and clinicians often reverse anticoagulation in patients who require emergency surgical procedures. Current guidelines for rapid anticoagulation reversal for emergency surgery recommend four-factor prothrombin complex concentrate and vitamin K coadministration. The authors reviewed the current evidence on prothrombin complex concentrate treatment for vitamin K antagonist reversal in the perioperative setting, focusing on comparative studies and in the context of intracranial hemorrhage and cardiac surgery. The authors searched Cochrane Library and PubMed between January 2008 and December 2017 and retrieved 423 English-language papers, which they then screened for relevance to the perioperative setting; they identified 36 papers to include in this review. Prothrombin complex concentrate therapy was consistently shown to reduce international normalized ratio rapidly and control bleeding effectively. In comparative studies with plasma, prothrombin complex concentrate use was associated with a greater proportion of patients achieving target international normalized ratios rapidly, with improved hemostasis. No differences in thromboembolic event rates were seen between prothrombin complex concentrate and plasma, with prothrombin complex concentrate also demonstrating a lower risk of fluid overload events. Overall, the studies the authors reviewed support current recommendations favoring prothrombin complex concentrate therapy in patients requiring vitamin K antagonist reversal before emergency surgery.

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Rapid Anticoagulation Reversal With Prothrombin Complex Concentrate Before Emergency Brain Tumor Surgery

Cited by 7 publications

References 31 publications

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience

Application of Computer-Based Simulation Teaching Combined with PBL in Colorectal Tumor Hemorrhage

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal

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