Timing of INR reversal using fresh-frozen plasma in warfarin-associated intracerebral hemorrhage

Murtaza Akhter, Andrea Morotti, Abigail Sara Cohen, Yuchiao Chang, Alison M. Ayres, Kristin Schwab, Anand Viswanathan, Mahmut Edip Gurol, Christopher David Anderson, Steven Mark Greenberg, Jonathan Rosand, Joshua Norkin Goldstein

Research output: Contribution to journalArticle

Abstract

Rapid reversal of coagulopathy is recommended in warfarin-associated intracerebral hemorrhage (WAICH). However, rapid correction of the INR has not yet been proven to improve clinical outcomes, and the rate of correction with fresh-frozen plasma (FFP) can be variable. We sought to determine whether faster INR reversal with FFP is associated with decreased hematoma expansion and improved outcome. We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with WAICH presenting to an urban tertiary care hospital from 2000 to 2013. Patients with baseline INR > 1.4 treated with FFP and vitamin K were included. The primary outcomes are occurrence of hematoma expansion, discharge modified Rankin Scale (mRS), and 30-day mortality. The association between timing of INR reversal, ICH expansion, and outcome was investigated with logistic regression analysis. 120 subjects met inclusion criteria (mean age 76.9, 57.5% males). Median presenting INR was 2.8 (IQR 2.3–3.4). Hematoma expansion is not associated with slower INR reversal [median time to INR reversal 9 (IQR 5–14) h vs. 10 (IQR 7–16) h, p = 0.61]. Patients with ultimately poor outcome received more rapid INR reversal than those with favorable outcome [9 (IQR 6–14) h vs. 12 (8–19) h, p = 0.064). We find no evidence of an association between faster INR reversal and either reduced hematoma expansion or better outcome.

Original languageEnglish
Pages (from-to)557-565
Number of pages9
JournalInternal and Emergency Medicine
Volume13
Issue number4
DOIs
Publication statusPublished - Jun 1 2018

Keywords

  • Anticoagulants
  • Cerebral hemorrhage
  • Intracerebral hemorrhage
  • Stroke
  • Warfarin

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

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  • Cite this

    Akhter, M., Morotti, A., Cohen, A. S., Chang, Y., Ayres, A. M., Schwab, K., Viswanathan, A., Gurol, M. E., Anderson, C. D., Greenberg, S. M., Rosand, J., & Goldstein, J. N. (2018). Timing of INR reversal using fresh-frozen plasma in warfarin-associated intracerebral hemorrhage. Internal and Emergency Medicine, 13(4), 557-565. https://doi.org/10.1007/s11739-017-1680-2