![]() This prospective study (August 2012 to February 2015), conducted in our stroke unit, included consecutive AIS patients who were otherwise eligible for IVT, except for VKA intake and INR >1.7. ![]() 4 This study was undertaken to determine whether IVT immediately after a 3-minute infusion of 4F-PCC and vitamin K could be feasible and safe in VKA-treated AIS patients with INR >1.7. 3 Only a few similar human cases given PCC have been reported. In a thromboembolic model of VKA-pretreated rodents, PCC prevented secondary hemorrhage post-IVT. 3 Pertinently, VKA-induced anticoagulation can be rapidly reversed by IV infusions of 4-factor prothrombin complex concentrate (4F-PCC) and vitamin K. 2 Although never clearly evaluated in humans, animal study results confirmed an excess bleeding risk after IVT with an elevated INR. 1 Intravenous thrombolysis (IVT) is not recommended for patients with INR >1.7. However, the annual acute IS (AIS) risk is as high as ≈1.7% for VKA-treated atrial fibrillation patients, occurring despite 30% of them having an international normalized ratio (INR) ≥2. Vitamin K antagonists (VKAs) are still used to prevent ischemic stroke (IS) in patients with atrial fibrillation and remain the only recommended oral treatment for patients with mechanical heart valves.
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