R.E.B.E.L.EM - June 15, 2020 - By Salim Rezaie
"Paper: Panos NG et al. Factor Xa Inhibitor-Related Intracranial Hemorrhage: Results From a Multicenter, Observational Cohort Receiving Prothrombin Complex Concentrates. Circulation 2020. PMID: 32264698
Clinical Question: What is the safety and efficacy of prothrombin complex concentrates (PCCs) for factor Xa inhibitor related intracranial hemorrhage (ICH)?
Author Conclusion: “Administration of PCCs after apixaban- and rivaroxaban-related ICH provided a high rate of excellent or good hemostasis (81.8%) coupled with a 3.8% thrombosis rate. Randomized, controlled trials evaluating the clinical efficacy of PCCs in patients with factor Xa inhibitor-related ICH are needed.”
Clinical Take Home Point: There is a true lack of prospective randomized clinical trials with respect to apixaban- and rivaroxaban-related ICH. This observational trial unfortunately doesn’t give us any real clinical guidance as there is no comparator arm and we simply don’t know what patient-oriented outcomes would be. Additionally, although the study tells us there is a low rate of VTE, we have no idea how robustly the authors screened for VTE (i.e. if you don’t look, you may not find VTE). Finally, physicians should be cautious of thromboembolic events out to 14 days after using PCCs."