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
Answer
--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.
