Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies.
Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n = 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression.
Results: We included 1,547 patients treated with FFP (n = 377, 24%), PCC (n = 585, 38%), both (n = 131, 9%), or neither (n = 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%, HR = 2.540, 95% confidence interval [CI] = 1.784-3.616, p < 0.001), followed by FFP alone (45.6%, HR = 1.344, 95% CI = 0.934-1.934, p = 0.112), then PCC alone (37.3%, HR = 1.445, 95% CI = 1.014-2.058, p = 0.041), compared to reversal with both FFP and PCC (27.8%, reference). Outcomes with PCC versus FFP were similar (HR = 1.075, 95% CI = 0.874-1.323, p = 0.492); 4-factor PCC (n = 441) was associated with higher case fatality compared to 3-factor PCC (n = 144, HR = 1.441, 95% CI = 1.041-1.995, p = 0.027).
Interpretation: The combination of FFP and PCC might be associated with the lowest case fatality in reversal of VKA-ICH, and FFP may be equivalent to PCC. Randomized controlled trials with functional outcomes are needed to establish the most effective treatment.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654243 | PMC |
| http://dx.doi.org/10.1002/ana.24416 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Neuroblastoma Occurring in Nijmegen Breakage Syndrome.
J Pediatr Hematol Oncol
January 2025
Medical Faculty, University of Belgrade.
Nijmegen breakage syndrome (NBS) is a rare primary immunodeficiency disease due to a pathogenic variant in the NBN gene causing impaired DNA repair and increased predisposition for lymphoid malignancy. By contrast, solid tumors have been rarely reported. Neuroblastoma (NB) is a rare childhood solid tumor, associated with the worse outcome if MYCN oncogene is amplified.
View Article and Find Full Text PDFFatal outcome related to drug reaction with eosinophilia and systemic symptoms: a disproportionality analysis of FAERS database and a systematic review of cases.
Front Immunol
December 2024
Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background: Drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening severe cutaneous adverse reaction.
Objective: This study aims to study fatal DRESS cases using FAERS database and systematic review.
Methods: Data of the FDA Adverse Event Reporting System (FAERS) database were extracted and manipulated.
Successful treatment of cardiac dysfunction due to left main trunk obstruction and severe acute aortic regurgitation secondary to acute type A aortic dissection using Impella: a case report.
J Cardiothorac Surg
December 2024
Department of Cardiovascular Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, 920-8641, Japan.
Background: Acute type A aortic dissection (A-AAD) with severe acute aortic regurgitation (AR) and coronary involvement is a potentially fatal condition that causes left ventricular volume overload and catastrophic acute myocardial infarction. We present the successful management of a patient using Impella 5.5 following cardiopulmonary arrest caused by A-AAD with severe acute AR and left main trunk (LMT) obstruction.
View Article and Find Full Text PDFEpithelioid hemangioendothelioma prognosis and outcome: report of two challenging cases.
J Cardiothorac Surg
December 2024
Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Background: Epithelioid hemangioendothelioma (EHE) is an uncommon vascular malignancy characterized by an unpredictable clinical course and a high potential for recurrence and metastasis. The lack of standard treatment guidelines, coupled with the tumor's inconsistent response to available treatments, complicates the management of EHE and leads to widely varying patient prognoses.
Case Presentation: We report two cases of EHE with distinct presentations reflecting the site of involvement.
Analysis of the efficacy and factors affecting the prognosis of intracranial dissecting aneurysm treated with multi-stent overlap technique.
BMC Neurol
December 2024
Department of Neurological Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, 183 Yiling Avenue, Yichang City, Wujiagang District, China.
Objective: The study aims to identify characteristics that impact the postoperative prognosis and recurrence of intracranial dissecting aneurysms (IDA) patients treated using multi-stent overlapping techniques.
Methods: Clinical data from 69 IDA patients treated with multistate-assisted spring coil embolization at the hospital between January 2017 and October 2023 were retrospectively reviewed, including clinical and imaging data gathered at admission and discharge. The prognosis was determined based on mRS grade at discharge, and the patients were divided into excellent prognosis (mRS 0-2 points) and poor prognosis (mRS 3-6 points).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!