Prehospital reversal of warfarin-related coagulopathy in intracerebral hemorrhage in a mobile stroke treatment unit.

Abstract

Warfarin-related intracerebral hemorrhage (ICH) accounts for 15% to 20% of all intraparenchymal hemorrhages and is associated with a much higher mortality than spontaneous ICH.1 Although rapid (ie, within 2 hours of onset) reversal of warfarin effect has been advocated,2,3 significant delays in initiation of therapy and correction of international normalized ratio are common.2 A mobile stroke treatment unit (MSTU) can deliver prehospital stroke care and can shorten the time to thrombolytic therapy in patients with ischemic stroke.4,5 MSTU can also deliver other therapies in acute neurological emergencies. Cleveland Clinic in collaboration with the Emergency Medical Services of the City of Cleveland implemented an MSTU starting July 18, 2014. We report on the prospectively collected data through August 31, 2014. The on-board MSTU team consists of a registered nurse, paramedic, emergency medical technician, and a computed tomography (CT) technologist. A cerebrovascular specialist evaluates the patient via telemedicine (InTouch RP-Xpress. Santa Barbara, CA), whereas a neuroradiologist remotely evaluates images obtained by a portable CT scanner (CereTom, Neurologica Corporation, Danvers, MA). Point-of-care laboratory testing routinely performed includes coagulation profile (coaguChek XS Pro, Roche Diagnostics, Indianapolis, IN), complete blood count (pocH 100i hematology analyzer, Sysmex Corporation, Kobe, Japan), and blood chemistry (iSTAT System, Abbott …