In their retrospective 5-year analysis, Kuwashiro and co-workers report the effects of prothrombin complex concentrate (PCC) administration on intracerebral hematoma enlargement, clinical outcome and in-hospital mortality in 50 patients under warfarin treatment presenting with intracerebral hemorrhage. Although it is known that PCC normalizes INR more rapidly than fresh frozen plasma or vitamin K, its effect on patients outcome remains unknown.

While no statistically significant results could be obtained when investigating the complete patient population, HE was lower, clinical outcome better and mortality reduced in a subgroup of 37 patients with an INR >2.0 on admission when PCC (500-1500 U) was administered. Unfortunately, a dose-efficacy recommendation could not be given. Also, complications of INR normalization were not investigated.

Although retrospective, nonrandomized, uncontrolled and based on a small sample size, the results of the study may support INR normalization with PCC in patients under warfarin and an INR >2 suffering from intracerebral hemorrhage in order to control hematoma enlargement and improve outcome. Prospective studies will have to be performed to strengthen this first impression and to propose effective and safe dosing regimens.

– Oliver Habler