The Neurocritical Care Society and Society of Critical Care Medicine just came out with new Guidelines for Reversal of Antithrombotics in Intracranial Hemorrhage (ICH) [1]
--PCC is now recommended over FFP in reversal of vitamin K antagonists (VKA) with elevated INR. Either should be co-administered with 10mg IV vitamin K. (Strong recommendation, moderate quality evidence)
TAKE AWAY: PCC should be probably be given over FFP in VKA-ICH when available
--Seems to be primarily based on a recent Lancet trial, which was stopped early due to safety concerns [2], but demonstrated more rapid reversal of INR and less hematoma expansion.
--In that study, all hematoma expansion related deaths occurred in the FFP group.
--Study was not designed to look at 90 day outcome, but trended towards improved survival.
1. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: Executive Summary. A Statement for Healthcare Professionals From the Neurocritical Care Society and the Society of Critical Care Medicine. Frontera JA, Lewin JJ 3rd, et al. Crit Care Med. 2016 Dec;44(12):2251-2257.
2. Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial. Steiner T, Poli S, et al. Lancet Neurol. 2016 May;15(6):566-73.