Warfarin reversal in anticoagulant-associated intracerebral hemorrhage
Warfarin reversal in anticoagulant-associated intracerebral hemorrhage
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DOI：
10.1007/s12028-008-9049-z
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发表时间：
2008-10-01
影响因子：
3.5
通讯作者：
Schwamm, Lee H.
中科院分区：
文献类型：
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作者：
Goldstein, Joshua N.;Rosand, Jonathan;Schwamm, Lee H.
抗凝剂相关性脑出血（ICH）是一种毁灭性的疾病，导致半数患者死亡，大多数幸存者终身残疾。患者入院后经常继续出血的发现提供了紧急华法林逆转可能会改善结果的可能性。由于没有临床试验证明任何一种治疗策略的优越性，因此有各种治疗方案可供选择。静脉注射维生素K是确定的治疗方法;然而，作为单一疗法，它可能需要几个小时才能生效。因此，它通常被认为是一种辅助剂。凝血因子可以用新鲜冷冻血浆（FFP）补充，FFP广泛可用且成本相对较低，但在现实环境中可能需要大量时间来递送。许多凝血因子产品统称为凝血酶原复合物浓缩物（PCC）是广泛可用的，可以快速提供许多或所有维生素K依赖性凝血因子。重组活化因子VII在许多中心用于此目的，因为它被认为提供促凝血作用，可以补偿其他关键因子的缺乏。在临床试验证明任何一种华法林逆转方法的优越性之前，可以使用一些来自国家组织的专家指南来帮助当地提供者指导治疗。在我们的机构，我们专注于改善静脉内维生素K和FFP组合的快速可靠输送，并继续重新给药，直到达到所需的INR降低。
Anticoagulant-associated intracerebral hemorrhage (ICH) is a devastating disease, causing death in half of patients and permanent disability in the majority of survivors. The finding that patients often continue bleeding after hospital presentation offers the possibility that emergency warfarin reversal may improve outcomes. As no clinical trials have demonstrated the superiority of any one treatment strategy, various treatment options are available. Intravenous vitamin K is the definitive therapy; however, as monotherapy it can require many hours to take effect. Therefore, it is often considered an adjunct agent. Coagulation factors can be repleted with fresh frozen plasma (FFP), which is widely available and relatively low cost, but can require substantial time to deliver in real-world settings. A number of coagulation factor products collectively termed prothrombin complex concentrates (PCCs) are widely available that can rapidly provide many or all the vitamin K-dependent coagulation factors. Recombinant activated factor VII is used in many centers for this purpose, as it is thought to provide a procoagulant effect that may compensate for the lack of the other critical factors. Until clinical trials demonstrate the superiority of any one means of warfarin reversal, a number of expert guidelines from national organizations are available to help local providers guide therapy. At our institution, we have focused on improving the rapid and reliable delivery of a combination of intravenous vitamin K and FFP, with continued re-dosing until the desired INR lowering is achieved.