{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:42:08Z","timestamp":1760197328610,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2018,4,25]],"date-time":"2018-04-25T00:00:00Z","timestamp":1524614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Objective: The number of patients presenting with warfarin-associated intracranial bleeding and needing neurosurgical intervention is growing. Prothrombin complex concentrate (PCC) is commonly used for anti-coagulation reversal before emergent surgery. We present our experience with PCC use in patients presenting with coagulopathy and needing urgent craniotomy. Methods: We retrospectively identified all patients presenting with intracranial bleeding and coagulopathy due to warfarin use, requiring urgent neurosurgical procedures, from January, 2014 (implementation of 4-PCC therapy) until December, 2016. For coagulation reversal, all patients received 4-PCC (Octaplex) and vitamin K. Results: Thirty-five consecutive patients (17 men; median age 72 years) were administered 4-PCC before emergent neurosurgical procedures. The majority of patients presented with traumatic subdural hematoma (62%) and spontaneous intracerebral hemorrhage (32%). All patients were taking warfarin. Median international normalized ratio (INR) on admission was 2.94 (range: 1.20 to 8.60). Median 4-PCC dose was 2000 I.U. (range: 500 I.U. to 3000 I.U.). There was a statically significant decrease in INR (p &lt; 0.01), PT (p &lt; 0.01), and PTT (p = 0.02) after 4-PCC administration. Postoperative INR values were \u22643.00 in all patients, and seven (20%) patients had normal INR values. There were no 4-PCC related complications. Four (11%) patients developed subdural\/epidural hematoma and 20 (57%) patients died. Mortality was associated with lower Glasgow coma scale (GCS) score. Conclusions: The 4-PCC facilitates INR reversal and surgery in patients presenting with warfarin-associated coagulopathy and intracranial bleeding requiring urgent neurosurgical intervention.<\/jats:p>","DOI":"10.3390\/medicina54020022","type":"journal-article","created":{"date-parts":[[2018,4,25]],"date-time":"2018-04-25T11:15:39Z","timestamp":1524654939000},"page":"22","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Bleeding in Neurosurgical Patients: A Single-Center Experience"],"prefix":"10.3390","volume":"54","author":[{"given":"Jomant\u0117","family":"Ma\u010diukaitien\u0117","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Bilskien\u0117","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arimantas","family":"Tama\u0161auskas","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania"},{"name":"Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adomas","family":"Bunevi\u010dius","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania"},{"name":"Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1865-1380-4-40","article-title":"Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: A structured literature review","volume":"4","author":"Bechtel","year":"2011","journal-title":"Int. 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