Use of factor IX complex in warfarin-related intracranial hemorrhage

OBJECTIVE: Anticoagulation-treated patients presenting with intracranial he morrhage, including subdural hematoma, epidural hematoma, subarachnoid hemo rrhage, and intracerebral hemorrhage, require urgent correction of their co agulopathy to prevent worsening hemorrhage and to facilitate surgical inter vention when necessary. In this study, we compared the use of fresh frozen plasma (FFP) with that of Factor IX complex concentrate (FIXCC) to achieve rapid correction of warfarin anticoagulation. METHODS: Patients admitted to a tertiary care center with computed tomograp hy-proven intracranial hemorrhage and a prothrombin time of more than 17 se conds were considered for inclusion in the study protocol. Complete data se ts were obtained for eight patients randomized to treatment with FFP and fi ve patients randomized to treatment with FFP supplemented with FIXCC. The p rothrombin time and International Normalized Ratio were measured every 2 ho urs for 14 hours. Correction of anticoagulation was defined as an Internati onal Normalized Ratio of less than or equal to 1.3. RESULTS: A difference in repeated International Normalized Ratio measuremen ts during the first 6 hours of correction was observed between the FIXCC an d FFP groups (P < 0.03). The rate of correction was greater (P < 0.01) and the time to correction was shorter (P < 0.01) for the FIXCC-treated group. No difference in neurological outcomes was detected between groups, but a h igher complication rate was observed for the FFP-treated group. CONCLUSION: The use of FIXCC accelerated correction of warfarin-related ant icoagulation in the presence of intracranial hemorrhage.