TY - JOUR
T1 - The Role of FEIBA in Reversing Novel Oral Anticoagulants in Intracerebral Hemorrhage
AU - Dibu, Jamil R.
AU - Weimer, Jonathan M.
AU - Ahrens, Christine
AU - Manno, Edward
AU - Frontera, Jennifer A.
N1 - Publisher Copyright:
© 2015, Springer Science+Business Media New York.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background: Activated prothrombin complex concentrates factor eight inhibitor bypassing activity (FEIBA) has been recommended for reversing novel oral anticoagulants (NOAC) in the context of intracerebral hemorrhage (ICH), though few clinical studies report its use. Methods: A prospective study of patients with spontaneous ICH was conducted from May 2013 to May 2015. Hospital complications including hemorrhage (gastrointestinal bleeding, anemia requiring transfusion, and surgical site bleeding) and thrombosis (pulmonary embolus, deep vein thrombosis, ischemic stroke, and myocardial infarction) were recorded. All ICH patients underwent baseline head CT and a follow-up stability scan in 6 h. NOAC taken within 48 h of presentation was reversed with FEIBA (50 u/kg) per protocol. Three-month outcomes were assessed using the modified rankin score (mRS). Results: Of 127 ICH patients enrolled, 6 (5 %) had NOAC-related ICH including: oral factor XA inhibitor N = 5 (4 %; N = 4 rivaroxaban, N = 1 apixaban] and direct thrombin inhibitor N = 1 (0.8 %; dabigatran). The indication for NOAC was atrial fibrillation in all patients and the median CHADS2–VASC score was 4 (range 2–5). The median admission NIHSS was 2 (range 0–14) and the median ICH volume was 8 mL (range 1–20). Five patients (3 rivaroxaban, 1 apixaban, 1 dabigatran) presented within 48 h and received FEIBA within a median of 13 h (range 10–29 h) from their last NOAC dose and 8 h (range 4.5–20) from the time last known well. None of the patients had ICH expansion, hemorrhagic, or thrombotic complications. Three-month median mRS was 1 (range 0–6). Conclusion: In this small case series, reversal of NOAC with FEIBA was not associated with ICH expansion or any thrombotic or hemorrhagic complications.
AB - Background: Activated prothrombin complex concentrates factor eight inhibitor bypassing activity (FEIBA) has been recommended for reversing novel oral anticoagulants (NOAC) in the context of intracerebral hemorrhage (ICH), though few clinical studies report its use. Methods: A prospective study of patients with spontaneous ICH was conducted from May 2013 to May 2015. Hospital complications including hemorrhage (gastrointestinal bleeding, anemia requiring transfusion, and surgical site bleeding) and thrombosis (pulmonary embolus, deep vein thrombosis, ischemic stroke, and myocardial infarction) were recorded. All ICH patients underwent baseline head CT and a follow-up stability scan in 6 h. NOAC taken within 48 h of presentation was reversed with FEIBA (50 u/kg) per protocol. Three-month outcomes were assessed using the modified rankin score (mRS). Results: Of 127 ICH patients enrolled, 6 (5 %) had NOAC-related ICH including: oral factor XA inhibitor N = 5 (4 %; N = 4 rivaroxaban, N = 1 apixaban] and direct thrombin inhibitor N = 1 (0.8 %; dabigatran). The indication for NOAC was atrial fibrillation in all patients and the median CHADS2–VASC score was 4 (range 2–5). The median admission NIHSS was 2 (range 0–14) and the median ICH volume was 8 mL (range 1–20). Five patients (3 rivaroxaban, 1 apixaban, 1 dabigatran) presented within 48 h and received FEIBA within a median of 13 h (range 10–29 h) from their last NOAC dose and 8 h (range 4.5–20) from the time last known well. None of the patients had ICH expansion, hemorrhagic, or thrombotic complications. Three-month median mRS was 1 (range 0–6). Conclusion: In this small case series, reversal of NOAC with FEIBA was not associated with ICH expansion or any thrombotic or hemorrhagic complications.
KW - Activated prothrombin complex concentrate
KW - Anticoagulant-related intracerebral hemorrhage reversal
KW - Intracerebral hemorrhage
KW - Novel oral anticoagulants
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U2 - 10.1007/s12028-015-0213-y
DO - 10.1007/s12028-015-0213-y
M3 - Article
C2 - 26545367
AN - SCOPUS:84946780153
SN - 1541-6933
VL - 24
SP - 413
EP - 419
JO - Neurocritical Care
JF - Neurocritical Care
IS - 3
ER -