PCC Not Linked With Better Outcomes in DOAC-Associated ICH

Prothrombin complex concentrate (PCC) treatment was not associated with improved functional outcome, hematoma expansion, or mortality compared with conservative management in patients who developed intracerebral hemorrhage (ICH) associated with direct oral anticoagulant use (DOAC). Researchers published their findings online in JAMA Network Open.

“ICH is the most severe complication during DOAC usage, with ethnicity, hypertension, advanced age, and cerebral small vessel disease being important risk factors of the condition,” researchers explained in the study introduction. “Although DOAC-associated ICH has extremely high mortality and morbidity, clinical effectiveness of current hemostatic strategies is unclear.”

The retrospective cohort study included 232 patients with DOAC-associated ICH in Hong Kong. Investigators compared outcomes of patients who received 25 to 50 IU/kg PCC with those who received no hemostatic agents.

Among all patients, 31% had good neurological recovery and 39% died within 90 days. Median hematoma volume at baseline was 21.7 mL. PCC treatment was not linked with improved neurological outcomes, hematoma expansion, or survival, the study found. Compared with conservative management, adjusted odds ratios were 0.62 for improved neurological recovery, 1.03 for mortality at 90 days, 1.11 for in-hospital mortality, and 0.94 for reduced hematoma expansion with PCC treatment.

Higher baseline hematoma volumes, lower Glasgow coma scale, and intraventricular hemorrhage were associated with worse outcomes, according to the study.

“In this cohort study, Chinese patients with DOAC-associated ICH had large baseline hematoma volumes and high rates of mortality and functional disability…” researchers wrote. “Further studies on novel hemostatic agents as well as neurosurgical and adjunctive medical therapies are needed to identify the best management algorithm for DOAC-associated ICH.”

Reference

Ip B, Pan S, Yuan Z, et al. Prothrombin complex concentrate vs conservative management in ICH associated with direct oral anticoagulants. JAMA Netw Open. 2024;7(2):e2354916. doi:10.1001/jamanetworkopen.2023.54916