Abstract Details

Title Factor VIIa before t-PA Is Safe in Acute Stroke Patients with INR Greater Than 1.7

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 043

Objective

Background BACKGROUND: In patients on warfarin therapy an international normalized ratio (INR) greater than 1.7 is a recognized contraindication for recombinant tissue plasminogen activator (t-PA) for acute ischemic stroke. Treatment options in these patients are limited. Factor VIIa has been used to quickly reverse elevated INR due to warfarin in patients with intracranial hemorrhages. We present 5 cases in which factor VIIa was used to reverse warfarin-induced coagulopathy prior to receiving IV t-PA.

Design/Methods DESIGN/METHODS: From 2007-2012, five acute ischemic stroke patients treated with factor VIIa prior to IV t-PA were identified and their records reviewed. All patients were on warfarin and had an INR greater than 1.7. Initial and discharge NIHSS scores, initial INRs and discharge dispositions were reviewed.

Results RESULTS: The range of INRs was from 1.8 to 2.9. The NIHSS scores ranged from 10 to 31. All patients had an improvement in NIHSS scores ranging from 4 to 16 points. There was an average 10.4 point improvement. Two patients were discharged home, one to a nursing home, one died with hospice, and one is currently awaiting discharge. There were no symptomatic intracranial hemorrhages nor were there any additional ischemic strokes, myocardial infarcts, deep vein thromboses or pulmonary emboli.

Conclusions CONCLUSIONS: Factor VIIa prior to t-PA for these five patients with acute ischemic stroke and INRs greater than 1.7 has been used safely. All patients had an improvement in NIHSS scores. This combined treatment showed potential for improved NIHSS scores and outcome. Further studies are needed to identify stroke patients who may benefit from this combination therapy.

Authors/Disclosures
Sarah Parker, MD (University of Tennessee Medical Center) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Deepak S. Nair, MD (OSF HealthCare)	Dr. Nair has nothing to disclose.
Arun V. Talkad, MD, BA (OSF Healthcare)	Dr. Talkad has nothing to disclose.
David Z. Wang, DO, FAHA, FAAN (BNI, Neurology, Stroke)	Dr. Wang has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Mediwelcome.
William W. Seeley, MD	Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG Council. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global Consulting. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BridgeBio. Dr. Seeley has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Seeley has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lyterian Therapeutics. The institution of Dr. Seeley has received research support from NIH. The institution of Dr. Seeley has received research support from Rainwater Charitable Foundation. The institution of Dr. Seeley has received research support from Bluefield Project to Cure FTD. The institution of Dr. Seeley has received research support from Chan-Zuckerberg Initiative.

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