Role of prothrombin complex concentrate (PCC) in Acute Intracerebral Hemorrhage with Positive CTA spot sign: An institutional experience at a regional and state designated stroke center.

Abstract

Our objective is to identify the effect of prothrombin complex concentrate (PCC) in acute intracranial hemorrhage (ICH) by evaluating intraparenchymal hematoma expansion between initial and follow-up head CT at 5-24h, in those with positive CTA spot sign (CTASS). CTASS is an independent predictor of hematoma growth (1). Acute ICH, regardless of etiology, can present with quick mental status decline often resulting in irreversible brain damage. Hematoma expansion appears to be a modifiable predictor of clinical outcome and an appropriate target for medical therapy. PCC is a procoagulant which is the agent of choice in warfarin-related ICH. We explore utility of PCC in all patients regardless of warfarin status. We retrospectively reviewed patients with ICH at our NY State designated Stroke Center from Nov 2013 to Dec 2015. Twenty-three of the 85 patients with ICH received PCC, of which 8 had positive CTASS (E=8). Four of the 62 patients without PCC, had a positive CTASS (C=4). Interval change in ICH volume at 5-24h was measured using ABC/2 formula, which is an accurate predictor of ICH volume (5). Control group (C) showed increase in mean ICH volume of 46% (SD=37.3%), whereas experimental group (E) showed a decrease of 13% (SD=29.9%) (p value = 0.012). We found a strong statistical correlation favoring our hypothesis. Use of PCC in active ICH with positive CTASS resulted in overall decrease in the mean hematoma size at 24h, whereas the control group showed an overall increase.