RESEARCH ARTICLE Reversal Strategies for Vitamin K Antagonists in Acute Intracerebral

Objective: There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antago-nists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n5 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio<1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. Results: We included 1,547 patients treated with FFP (n5377, 24%), PCC (n5 585, 38%), both (n5 131, 9%), or nei-ther (n5 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%