Prothrombin Complex Concentrate vs Conservative Management in ICH Associated With Direct Oral Anticoagulants

Ip, B; Pan, S; Yuan, Z; Hung, T; Ko, H; Leng, X; Liu, Y; Li, S; Lee, SY; Cheng, C; Chan, H; Mok, V; Soo, Y; Wu, X; Lui, LT; Chan, R; Abrigo, J; Dou, Q; Seiffge, D; Leung, T

doi:10.1001/jamanetworkopen.2023.54916

Trauma & major bleeding

Prothrombin Complex Concentrate vs Conservative Management in Intracerebral Hemorrhage (ICH) Associated With Direct Oral Anticoagulants

JAMA Netw OpenPublished 5 Feb 2024Retrospective cohort study

An erratum to this article was published (JAMA Netw Open, 5 Feb 2024 ↗)

Main finding · Good neurological recoveryResultAdjusted odds ratio 0.62 95% CI 0.33–1.16

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Authors' conclusion

PCC treatment was not associated with improved functional outcome, hematoma expansion, or mortality.

Study context

Population: Patients with Direct Oral Anticoagulant (DOAC)-associated ICH, Hong Kong, January 1, 2016, to December 31, 2021
Participants: 232 patients

Exposure: Prothrombin complex concentrate (PCC) vs conservative management
PCCn = 102
Conservativen = 116reference
Outcome: Modified Rankin scale of 0 to 3 or returning to baseline functional status
Follow-up: 3 months

Methodological detailspopulation-based, propensity score-weighted

Population-based
Propensity score-weighted

Main finding

Good neurological recovery

Adjusted odds ratio

0.62

95% CI 0.33–1.16

P = 0.14

PCC vs Conservative

aOR 0.62 (95% CI 0.33–1.16); P = 0.14

As reported in the abstract

Good neurological recovery, overall: 74 (31%)

Observational data: associations, not effects.

Secondary outcomes

Outcome	← Lower odds with PCC ←→ Higher odds with PCC →	aOR (95% CI)	P value
Mortality at 90 days	0.20.5125	1.03 (0.70–1.53)	P = 0.88
In-hospital mortality	0.20.5125	1.11 (0.69–1.79)	P = 0.66
Hematoma expansion	0.20.5125	0.94 (0.38–2.31)	P = 0.90
	0.20.5125Adjusted odds ratio (log scale)

Mortality at 90 days — Died within 90 days, overall: 92 (39%)

Factors associated with outcomes (unweighted)

Higher baseline hematoma volume, lower GCS and intraventricular hemorrhage associated with lower odds of good neurological outcome but not hematoma expansion

Original publication

Prothrombin Complex Concentrate vs Conservative Management in ICH Associated With Direct Oral Anticoagulants. JAMA Netw Open. Published 5 February 2024. doi:10.1001/jamanetworkopen.2023.54916

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