Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies

The incidence of spontaneous intracranial haemorrhage has increased markedl y in line with the increased use of oral anticoagulant agents. Recent guide lines for reversal of this acquired coagulation defect in an emergency have been established, but they are not adhered to in all centres. Our unit is referred between 20 and 60 patients per year (1994-1999) who are anticoagul ated and require urgent neurosurgical intervention. In order to investigate this, we performed a prospective study using prothrombin complex concentra te (PCC). PCC was given to the first six patients with intracranial haemorr hage admitted to the neurosurgical unit requiring urgent correction of anti coagulation (Group 1) and compared with patients receiving standard treatme nt with fresh frozen plasma and vitamin K (Group 2). Mean International Nor malised Ratios of Group 1 were 4.86 pretreatment and 1.32 posttreatment, an d of Group 2 were 5.32 and 2.30, respectively. Results for complete reversa l and reversal time were significant for PCC with p<0.001. We recommend PCC for rapid and effective reversal of warfarin in life-threatening neurosurg ical emergencies.