Choosing the Best Approach to Warfarin Reversal After Traumatic Intracranial Hemorrhage

Authors

Shunella G. Lumas, Division of General Surgery, Department of Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut.
Walter Hsiang, Division of General Surgery, Department of Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut.Follow
Robert D. Becher, Division of General Surgery, Department of Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut.Follow
Adrian A. Maung, Division of General Surgery, Department of Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut.Follow
Kimberly A. Davis, Division of General Surgery, Department of Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut.Follow
Kevin M. Schuster, Division of General Surgery, Department of Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut. Electronic address: kevin.schuster@yale.edu.Follow

Document Type

Article

Publication Title

The Journal of surgical research

Abstract

BACKGROUND: Patients on warfarin with traumatic intracranial hemorrhage often have the warfarin effects pharmacologically reversed. We compared outcomes among patients who received 4-factor prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), or no reversal to assess the real-world impact of PCC on elderly patients with traumatic intracranial hemorrhage (ICH). MATERIALS AND METHODS: This was a retrospective analysis of 150 patients on preinjury warfarin. Data were manually abstracted from the electronic medical record of an academic level 1 trauma center for patients admitted between January 2013 and December 2018. Outcomes were ICH progression on follow-up computed tomography scan, mortality, need for surgical intervention, and trends in the use of reversal agents. RESULTS: Of 150 patients eligible for analysis, 41 received FFP, 60 PCC, and 49 were not reversed. On multivariable analysis, patients not reversed [OR 0.25 95% CI (0.31-0.85)] and women [OR 0.38 95% CI (0.17-0.88)] were less likely to experience progression of their initial bleed on follow-up computed tomography while subdural hemorrhage increased the risk [OR 3.69 95% CI (1.27-10.73)]. There was no difference between groups in terms of mortality or need for surgery. Over time use of reversal with PCC increased while use of FFP and not reversing warfarin declined (P < 0.001). CONCLUSIONS: Male gender and using a reversal agent were associated with progression of ICH. Choice of reversal did not impact the need for surgery, hospital length of stay, or mortality. Some ICH patients may not require warfarin reversal and may bias studies, especially retrospective studies of warfarin reversal.

First Page

369

Last Page

376

DOI

10.1016/j.jss.2020.12.004

Publication Date

4-1-2021

Recommended Citation

Lumas, Shunella G.; Hsiang, Walter; Becher, Robert D.; Maung, Adrian A.; Davis, Kimberly A.; and Schuster, Kevin M., "Choosing the Best Approach to Warfarin Reversal After Traumatic Intracranial Hemorrhage" (2021). Surgery. 40.
https://scholar.bridgeporthospital.org/surgery/40

Identifier

33388533 (pubmed); 10.1016/j.jss.2020.12.004 (doi); S0022-4804(20)30856-8 (pii)