Scarce and contradicting data exists on outcomes in patients presenting with intracerebral hemorrhage (ICH) while on vitamin K antagonist (VKA). We hypothesized that early reversal of ICH would impact outcomes in this patient population.

ICH is a known complication of VKA use, leading to high morbidity and mortality. Current guidelines recommend prompt reversal of international normalized ratio (INR) with vitamin K, prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), recombinant factor VIIa, or combinations of these agents. Presumption is that early reversal improves outcomes, reduces mortality, and limits hemorrhage expansion, but outcomes data is limited.

We retrospectively analyzed all patients presenting to Rush University from January 2013 to June 2018 with ICH on VKA. Patients with insufficient data were excluded. Data collected included age, disposition, ICH score, type of anticoagulant, antiplatelet, initial INR, time to reversal (INR < 1.4), and reversal agents used. Association measures were performed using simple logistic regression methods, and a prediction model built using multiple logistic regression.

A total of 140 patients were reviewed, 85 included for analysis. Delayed normalization of INR (> 6 hours), initial INR > 3, type of reversal agent (FFP vs PCC), age > 65 and previous use of antiplatelet agents were not predictive of disfavorable functional outcome (death or discharge to a facility other than home or acute rehabilitation). Patients with an ICH score > 1 on admission were significantly more prone to experience a worse outcome (p 0.008, OR 4.33, CI 1.45-12.95). Findings persisted in a logistic regression model corrected for all the above cited variables. Results were unchanged if the outcome was considered as crude mortality solely.