Coagulation factor VIIa (recombinant) for warfarin-induced intracranial hemorrhage

Purpose. The use of coagulation factor Vila (recombinant) for the treatment of warfarin-induced intracranial hemorrhage (ICH) is described. Summary. ICH is a devastating disorder that can be exacerbated by the use of oral anticoagulation. The treatment of warfarin associated ICH involves the prompt reversal of anticoagulation to allow for surgical procedures, if necessary. Despite limited labeled indications, factor Vila (recombinant) has been used to reverse warfarin-induced anticoagulation in patients with active hemorrhage, partly due to the rapid effect of factor Vila on the International Normalized Ratio and the ability to administer the drug quickly in acute settings. The efficacy of factor Vila (recombinant) for the reversal of anticoagulation in patients with warfarin-associated ICH has been described in several case reports, case series, and retrospective cohort studies. Based on these reports, the use of factor Vila (recombinant) for the treatment of warfarin-associated ICH may be a viable alternative or adjunct therapy to standard treatment with fresh-frozen plasma and vitamin K. However, due to the nature of these reports, future controlled trials should be conducted to verify the exact place for factor Vila (recombinant) for this indication. Thromboembolic complications are rare but serious complications secondary to the use of factor Vila (recombinant). Though differences exist in the reported rate of thromboembolic complications associated with factor Vila (recombinant), factor Vila (recombinant) should be used with caution in patients with a predisposition to thromboembolic complications. Conclusion. Use of factor Vila (recombinant) may be considered for reversal of anticoagulation in patients with warfarin-associated ICH. However, patients should be screened for increased risk of thrombosis before administration of the drug.