Point-of-Care Reversal Treatment in Phenprocoumon-Related Intracerebral Hemorrhage

被引:32
作者
Rizos, Timolaos [1 ]
Jenetzky, Ekkehart [2 ]
Herweh, Christian [3 ]
Hug, Andreas [1 ]
Hacke, Werner [1 ]
Steiner, Thorsten [1 ]
Veltkamp, Roland [1 ]
机构
[1] Heidelberg Univ, Dept Neurol, D-69120 Heidelberg, Germany
[2] German Canc Res Ctr, Dept Clin Epidemiol & Aging Res, Heidelberg, Germany
[3] Heidelberg Univ, Dept Neuroradiol, D-69120 Heidelberg, Germany
关键词
PROTHROMBIN COMPLEX CONCENTRATE; ORAL ANTICOAGULANT-THERAPY; WARFARIN REVERSAL; VITAMIN-K; MANAGEMENT; STROKE; GUIDELINES; GROWTH; ADULTS; INR;
D O I
10.1002/ana.21965
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Rapid reversal of the anticoagulatory effect of vitamin K antagonists represents the primary emergency treatment for oral anticoagulant-related intracerebral hemorrhage (OAC-ICH). Predicting the amount of prothrombin complex concentrate (PCC) needed to reverse OAC in individual patients is difficult, and repeated international normalized ratio (INR) measurements in central laboratories (CLs) are time-consuming. Accuracy and effectiveness of point-of-care INR coagulometers (POCs) for INR reversal in OAC-ICH have not been evaluated. Methods: In phase 1, the agreement of emergency POC and CL INR measurements was determined. In phase 2, stepwise OAC reversal was performed with PCC using a predetermined dosing schedule. Concordance of POC and CL INR measurements during reversal and time gain due to POC were determined. Results: In phase 1 (n = 165), Bland-Altman analysis showed close agreement between POCs and CLs (mean INR deviation 0.04). In phase 2 (n = 26), POCs caused a median initial net time gain of 24 minutes for the start of treatment with PCC. Median time for POC-documented complete OAC reversal was 28 minutes, compared with 120 minutes for CLs. Bland-Altman analysis between POCs and CLs revealed a mean INR deviation of 0.13 during stepwise PCC administration. POCs tended to slightly overestimate the INR, especially at higher INR levels. Remarkably, POC-guided reversal led to a median reduction of 30.5% of PCC dose compared with the a priori dose calculation. Hematomas enlarged in 20% of patients. Interpretation: POC INR monitoring is a fast, effective, and economic means of PCC dose-titration in OAC-ICH. Larger studies examining the clinical efficacy of this procedure are warranted. ANN NEUROL 2010;67:788-793
引用
收藏
页码:788 / 793
页数:6
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