Treatment With Prothrombin Complex Concentrate to Enable Emergency Lumbar Puncture in Patients Receiving Vitamin K Antagonists - 25/08/16
Abstract |
Study objective |
Lumbar punctures are frequently necessary in neurologic emergencies, but effective oral anticoagulation with vitamin K antagonists represents a contraindication. We report the effectiveness of prothrombin complex concentrates to reverse vitamin K antagonist to enable emergency lumbar punctures, as well as evaluate lumbar puncture– and prothrombin complex concentrates–related complications.
Methods |
Consecutive patients treated with prothrombin complex concentrates between December 2004 and June 2014 to enable emergency lumbar puncture were included. International normalized ratio (INR) before and after prothrombin complex concentrates treatment and the time between start of reversal treatment and lumbar puncture were recorded. A target INR of less than or equal to 1.5 was defined as effective prothrombin complex concentrates treatment. Bleeding events, thromboembolic events, and allergic reactions after prothrombin complex concentrates treatment were identified and classified as “related,” “probably,” “possibly,” “unlikely related,” or “not related” to the lumbar puncture and prothrombin complex concentrates infusion.
Results |
Thirty-seven patients were included (64.9% men; median age 76.0 years; interquartile range [IQR] 71.0 to 84.0 years). The intervention with prothrombin complex concentrates was effective in 33 of 37 patients (89.2%; 95% confidence interval [CI], 78.4% to 97.3%). The median INR was 2.2 (IQR 1.8 to 2.9; 95% CI, 1.9 to 2.5) before and 1.3 (IQR 1.2 to 1.4; 95% CI, 1.2 to 1.3) after prothrombin complex concentrates treatment. The median time between start of prothrombin complex concentrates treatment and lumbar puncture was 135 minutes (IQR 76 to 266 minutes; 95% CI, 84 to 198 minutes). One clinically irrelevant intracranial subdural hematoma “related” to the lumbar puncture developed. No allergic reaction was observed, but 2 of 37 patients (5.4%; 95% CI, 0% to 13.5%) experienced a thromboembolic event (1 ischemic stroke, classified “unlikely related,” and 1 myocardial infarction, “possibly related” to prothrombin complex concentrates treatment).
Conclusion |
Reversing the effect of vitamin K antagonist with prothrombin complex concentrates to enable emergency lumbar puncture appears effective and safe, particularly in regard to bleeding events.
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| Please see page 341 for the Editor’s Capsule Summary of this article. |
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| Supervising editors: William J. Meurer, MD, MS; Donald M. Yealy, MD |
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| Author contributions: ML, CB, and TR conceived the study. ML and TR supervised performance and data collection of the study, performed statistical analyses, and drafted the article. PS performed chart review and data collection. MM reviewed imaging data. ML, OM, and TR reviewed and interpreted the data. All authors contributed substantially to article revision. TR takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. Laible is supported by a fellowship from the Medical Faculty, University of Heidelberg. Dr. Beynon received speaker honoraria from CSL Behring. Dr. Purrucker received travel and congress participation support from Pfizer. Dr. Müller received speaker honoraria from Daichii Sankyo, Boehringer Ingelheim, Bayer HealthCare, BMS, and Pfizer and served on the advisory boards of Bayer and Boehringer Ingelheim. Dr. Möhlenbruch received consulting honoraria from Acandis, Codman, MicroVention, and Phenox. Dr. Ringleb received consulting and speakers’ honoraria from Bayer HealthCare, Boehringer Ingelheim, Daiichi Sankyo, and GlaxoSmithKline. Dr. Rizos received consulting honoraria, speaker honoraria, and travel support from BMS Pfizer, Boehringer Ingelheim, Bayer HealthCare, and Daichii Sankyo. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 68 - N° 3
P. 340-344 - settembre 2016 Ritorno al numero
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