Recombinant factor VIIa for warfarin-associated intracranial bleeding

Study objectiveTo examine the efficacy of recombinant factor VIIa (rVIIa) in reversing warfarin-induced coagulopathy in trauma patients presenting with intracranial hemorrhage (ICH).DesignRetrospective, cohort-controlled database review.SettingLevel 1, university-affiliated trauma center.Patients54 patients presenting with ICH associated with chronic warfarin therapy, 30 of whom were treated with rVIIa, and the other 24 patients treated conventionally.MeasurementsWe examined initial and subsequent coagulation studies (prothrombin time, international normalized ratio [INR]), blood product requirement, and clinical outcome, including time to reverse anticoagulation, duration of reversal, and subsequent mortality.Main resultsPatients treated with rVIIa required significantly less plasma (4 vs 7 units) to correct their INR, and corrected in a much shorter period of time (2.4 vs10 hrs). The duration of corrected INR after rVIIa was dose-dependent.ConclusionsFactor rVIIa provides prompt correction of the INR of dose-dependent duration in patients with ICH intracranial hemorrhage associated with warfarin use.