It is essential to include vitamin K in the treatment regimen selleck chemicals llc since PCC has transient effects [40]. In our cohort, 576 patients (84.7%) received concomitant vitamin K. In a study including 18 patients with intracranial bleeding requiring neurosurgical intervention and treated with PCC (Kaskadil, LFB, Courtaboeuf, France). Vigue and colleagues [41] reported that INR was less than 1.5 within 6 to 12 hours after PCC infusion in 14 patients. The target INR was not reached in the four remaining patients for whom vitamin K had been omitted. In our cohort, no impact of vitamin K was found on target INR achievement.Patients presenting with intracranial hemorrhage generally have a poor prognosis compared with that of patients with other bleeding sites. Survival rates were 75.4% in the overall population and 65.
1% in patients with intracranial hemorrhage. VKA-related intracranial hemorrhages are reported to have a 50% mortality rate at 1 month [7]. The mortality rate of patients with intracranial hemorrhage depends of the site of hemorrhage [42,43], but unfortunately we did not collect details on the type of intracranial hemorrhage.As highlighted by Makris and Van Veen [44] in an editorial introducing the results of a study by Imberti and colleagues [45], the fact that a significant proportion of patients died suggests that the PCC was appropriately administered to those with life-threatening bleeding. In our cohort, 52% of patients were older than 80, and old age is known to be a predictor of poor prognosis.
Rapid anticoagulation reversal may lead to smaller hematoma and shorter delays before neurosurgical interventions and consequently to a better clinical outcome [46]. In our study, we found that achievement of target INR and bleeding control were strongly associated with survival. Antiplatelet agents have been suspected to increase hematoma growth and therefore to impair prognosis [47], but the mortality rate in this study did not differ, regardless of whether antiplatelets were used. The time between symptom onset and INR normalization is likely to be an important prognostic factor. Unfortunately, we did not study the time from symptom onset to admission or the time between admission and PCC administration, since our study was designed to describe the modalities of PCC use only. This time should be explored in a further study.
The anticoagulation reversal in patients with underlying thrombotic disease may be associated with a small risk of thromboembolic events. Given the heterogeneity in the composition of different formulations of PCC, the risk of thrombogenicity may vary [11,28]. The presence Anacetrapib of procoagulant factors, such as factors II and X, and of preactivated factors, such as factor VII, increases the risk of thrombogenicity [48]. However, proteins C and S prevent excessive coagulation [49]. Risk factors are also related to the patient’s underlying condition.
Related posts:
- Pazopanib GW786034 patients with deep leg vein thrombosis or PE in which study treatment
- Genistein search for risks for arthralgia and risks for baseline serum vitamin D levels
- Between treatment difference in the cumulative incidence of each category of fracture
- The presence of over one particular further patient- or treatment-related threat
- Activated Akt can phosphorylate several proteins which include gl