Reversal of the International Normalized Ratio with recombinant activated factor VII in central nervous system bleeding during warfarin thromboprophylaxis: clinical and biochemical aspects
Reversal of the International Normalized Ratio with recombinant activated factor VII in central nervous system bleeding during warfarin thromboprophylaxis: clinical and biochemical aspects
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DOI：
10.1097/00001721-200307000-00007
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发表时间：
2003-07-01
影响因子：
1.1
通讯作者：
Ingerslev, J
中科院分区：
文献类型：
--
作者：
Sorensen, B;Johansen, P;Ingerslev, J
大出血是与使用维生素k拮抗剂（VKA）预防血栓相关的常见和危险并发症。建议在VKA治疗期间控制国际标准化比率（INR）升高和出血事件的方案包括给予维生素K，输注新鲜冷冻血浆（FFP）或凝血酶原复合物浓缩物（PCC）。相比之下，本通讯首次报道了重组病毒（rFVIIa）作为7例中枢神经系统（CNS）出血急诊患者的额外治疗的有效使用。预处理INRs范围为1.7 - 6.6，单次给药（10-40马克杯/千克）后10分钟，所有INRs均小于或等于1.5。6例患者行中枢神经系统血肿引流术，全部存活。未发现凝血激活的不良生化征象，未发现血栓栓塞的发生。在离体实验研究中，25例接受VKA治疗的患者（INR为1.7-4.3）通过血栓造影评估了连续全血凝块形成的情况，结果显示，起始期明显延长，凝块形成的传播减少。6例患者体外补充rFVIIa后，凝块起始时间明显缩短，但最大凝块形成速度发生了变化。离体实验和我们的临床数据支持了最近的建议，即rFVIIa可能替代输注FFP或PCC用于VKA治疗的急性逆转。(C) 2003利平科特·威廉姆斯·威尔金斯。
Major bleeding is a frequent and hazardous complication associated with thromboprophylaxis using vitamin-K antagonists (VKA). Suggested regimens for control of highly elevated International Normalized Ratio (INR) and hemorrhagic events during VKA treatment include administration of vitamin K, infusion of fresh frozen plasma (FFP) or a prothrombin complex concentrate (PCC). In contrast this communication present the first report on the efficacious use of recombinant factor Vila (rFVIIa) as additional therapy in seven patients presenting with central nervous system (CNS) bleeding emergencies. Pretreatment INRs ranged from 1.7 to 6.6, and 10 min after a single dose of rFVIIa (10-40 mug/kg) all INRs were less than or equal to 1.5. Six patients underwent drainage of the CNS hematoma and all patients survived. No untoward biochemical signs of coagulation activation were detected and no incidence of thromboembolism was observed. In ex-vivo experimental studies, profiles of continuous whole blood clot formation were evaluated by thrombelastography in 25 patients on VKA treatment (INR 1.7-4.3), demonstrating a significantly prolonged initiation phase and diminished propagation of clot formation. Ex-vivo supplementation with rFVIIa to blood of six patients returned a distinct reduction of the prolonged initiation but variable changes in the maximum velocity of clot formation. The ex-vivo experiments and our clinical data support recent suggestions that rFVIIa might substitute for infusion of FFP or PCC in acute reversal of VKA treatment. (C) 2003 Lippincott Williams Wilkins.