The following is a summary of “Prothrombin complex concentrate administration timing in warfarin-associated intracranial hemorrhage,” published in the February 2024 issue of Emergency Medicine by Townsend, et al.

Guidelines emphasize the importance of rapid anticoagulation reversal in the treatment of warfarin-associated intracranial hemorrhage (ICH), yet they lack specific time-to-administration goals. Limited research exists on the association between time and reversal, particularly with 4-factor prothrombin concentrate (4F-PCC), hematoma expansion, and outcomes within intervals of less than 4 hours. For a study, researchers sought to investigate the impact of time-to-administration of 4F-PCC on achieving effective hemostasis, as indicated by hematoma expansion, in patients with warfarin-associated ICH.

Conducted as a retrospective, observational study at a large community teaching hospital, patients were categorized into three groups based on the time from CT diagnosis of ICH to the administration of 4F-PCC: <45 minutes, 45–90 minutes, and >90 minutes. The primary outcome measured was the rate of achieving effective hemostasis, defined as a ≤20% increase in hematoma volume as assessed by a radiologist.

Among 227 screened patients, 39 were ultimately included in the study, with similar baseline characteristics across the groups. The primary outcome of achieving effective hemostasis did not significantly differ among the groups stratified by time to 4F-PCC administration (<45 minutes, 45–90 minutes, and >90 minutes) (85.7% vs 73.3% vs 90%, P-value 0.514). Secondary outcomes, including in-hospital mortality, hospital length of stay (LOS), and intensive care unit LOS, also showed no significant differences between the groups.

The study found no association between time-to-administration of 4F-PCC and the achievement of hemostasis, defined by a ≤20% increase in hematoma volume, in patients with warfarin-associated ICH.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006502