Recombinant factor VIIa for warfarin-associated intracranial bleeding

J Clin Anesth. 2008 Jun;20(4):276-9. doi: 10.1016/j.jclinane.2007.12.012.


Study objective: To examine the efficacy of recombinant factor VIIa (rVIIa) in reversing warfarin-induced coagulopathy in trauma patients presenting with intracranial hemorrhage (ICH).

Design: Retrospective, cohort-controlled database review.

Setting: Level 1, university-affiliated trauma center.

Patients: 54 patients presenting with ICH associated with chronic warfarin therapy, 30 of whom were treated with rVIIa, and the other 24 patients treated conventionally.

Measurements: We examined initial and subsequent coagulation studies (prothrombin time, international normalized ratio [INR]), blood product requirement, and clinical outcome, including time to reverse anticoagulation, duration of reversal, and subsequent mortality.

Main results: Patients treated with rVIIa required significantly less plasma (4 vs 7 units) to correct their INR, and corrected in a much shorter period of time (2.4 vs 10 hrs). The duration of corrected INR after rVIIa was dose-dependent.

Conclusions: Factor rVIIa provides prompt correction of the INR of dose-dependent duration in patients with ICH intracranial hemorrhage associated with warfarin use.

MeSH terms

  • Aged
  • Anticoagulants / adverse effects*
  • Blood Coagulation / drug effects*
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Factor VIIa / therapeutic use*
  • Female
  • Humans
  • Intracranial Hemorrhages / chemically induced
  • Intracranial Hemorrhages / drug therapy*
  • Male
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Time Factors
  • Warfarin / adverse effects*


  • Anticoagulants
  • Recombinant Proteins
  • Warfarin
  • recombinant FVIIa
  • Factor VIIa