Observational studyAnnals of neurology2015
Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage.
Observational study in Annals of neurology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 5 syntheses or guidelines pooled it, 87 citations in OpenAlex.
- Safety and efficacy of prothrombin complex concentrate (PCC) for anticoagulation reversal in patients undergoing urgent neurosurgical procedures: a systematic review and metaanalysis.Neurosurgical review · 2021Pooled it
- Meta-analysis of haematoma volume, haematoma expansion and mortality in intracerebral haemorrhage associated with oral anticoagulant use.Journal of neurology · 2019Pooled it
- Pooled it
- Efficacy and safety of prothrombin complex concentrate for vitamin K antagonist-associated intracranial hemorrhage: a systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2019Pooled it
- Anticoagulation reversal in vitamin K antagonist-associated intracerebral hemorrhage: a systematic review.Journal of thrombosis and thrombolysis · 2018Pooled it
- Effect on Mortality of Anticoagulant Reversal in Acute Intracranial Hemorrhage: A Systematic Review and Meta-analysis.Neurocritical care · 2026Article
- Emergency Reversal of Antithrombotics in Intracerebral Hemorrhage: An Update.Current neurology and neuroscience reports · 2025Review
- Principles of reversal of anticoagulation in patients with intracerebral hemorrhage related to oral anticoagulants.European stroke journal · 2025Review
- Reversal of anticoagulation in patients with intracerebral haemorrhage related to oral anticoagulants: State of the evidence.European stroke journal · 2025Review
- Predictors of Intracranial Hemorrhage Volume Expansion in Patients Receiving Factor Xa Inhibitors in ANNEXA-4: Time and Severity Matter Most.Stroke (Hoboken, N.J.) · 2024Article
- Pharmacokinetics of Phenprocoumon in Emergency Situations-Results of the Prospective Observational RADOA-Registry (Reversal Agent Use in Patients Treated with Direct Oral Anticoagulants or Vitamin K Antagonists Registry).Pharmaceuticals (Basel, Switzerland) · 2022Article
- Management of Coagulopathy in Bleeding Patients.Journal of clinical medicine · 2021Review
- Are do-not-resuscitate orders associated with limitations of care beyond their intended purpose in patients with acute intracerebral haemorrhage? Analysis of the ABC-ICH study.BMJ open quality · 2021Observational
- Decision-Making Process for the Management of Acute Stroke in Patients on Oral Anticoagulant: From Guidelines to Clinical Routine.Frontiers in neurology · 2021Review
- Implementation of a prealert to improve in-hospital treatment of anticoagulant-associated strokes: analysis of a prehospital pathway change in a large UK centralised acute stroke system.BMJ open quality · 2020Article
- Coagulopathy reversal in intracerebral haemorrhage.Stroke and vascular neurology · 2020Review
- European Stroke Organisation Guideline on Reversal of Oral Anticoagulants in Acute Intracerebral Haemorrhage.European stroke journal · 2019Article
- An Intracerebral Hemorrhage Care Bundle Is Associated with Lower Case Fatality.Annals of neurology · 2019Article
- Article
- Recent advances in spontaneous intracerebral hemorrhage.F1000Research · 2019Review
Corrections and comments
- Commented on byReply.2016
- Commented on by
Authors and funding
33 authors at 16 institutions in 9 countries.
Funding
Abstract
objectiveThere is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies.
methodsWe pooled individual ICH patient data from 16 stroke registries in 9 countries (n = 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression.
resultsWe included 1,547 patients treated with FFP (n = 377, 24%), PCC (n = 585, 38%), both (n = 131, 9%), or neither (n = 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%, HR = 2.540, 95% confidence interval [CI] = 1.784-3.616, p < 0.001), followed by FFP alone (45.6%, HR = 1.344, 95% CI = 0.934-1.934, p = 0.112), then PCC alone (37.3%, HR = 1.445, 95% CI = 1.014-2.058, p = 0.041), compared to reversal with both FFP and PCC (27.8%, reference). Outcomes with PCC versus FFP were similar (HR = 1.075, 95% CI = 0.874-1.323, p = 0.492); 4-factor PCC (n = 441) was associated with higher case fatality compared to 3-factor PCC (n = 144, HR = 1.441, 95% CI = 1.041-1.995, p = 0.027).
interpretationThe combination of FFP and PCC might be associated with the lowest case fatality in reversal of VKA-ICH, and FFP may be equivalent to PCC. Randomized controlled trials with functional outcomes are needed to establish the most effective treatment.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.