Reversal of Warfarin Anticoagulation with Prothrombin Complex Concentrate before Thrombolysis for Acute Stroke
Bibliographic record
Abstract
An 84-year-old woman with myasthenia gravis and atrial fibrillation presented with impaired consciousness, neglect, left hemianopsia, hemiplegia and hemianesthesia [National Institutes of Health Stroke Scale (NIHSS) score 24]. Imaging at 50 min showed right middle cerebral artery (MCA) thrombus, but no ischemic change (fig. 1a, b). She was taking warfarin [international normalized ratio (INR) 2.0], precluding thrombolysis. Mechanical revascularization was unavailable hence consent was obtained to reverse anticoagulation with prothrombin complex concentrate (PCC). Fifteen minutes after PCC (40 ml dose, 1,000 IU factor IX activity), the INR was 1.2 and i.v. tissue plasminogen activator (tPA) was administered. Computed tomography (CT) at 24 h showed thrombus resolution and infarct limited to the lentiform nucleus with no filling defect on CT angiogram (fig. 1c, d). She was discharged at day 7 to a rehabilitation center (NIHSS score 6). At 8 weeks, her NIHSS score was 4.PCC contains factors II, VII, IX, X, protein C and protein S and causes rapid reversal of warfarin-induced coagulopathy [1]. Routine use of PCC in acute stroke is not recommended due to the thrombotic risk estimated between 1–2% [2]. However, proximal MCA occlusions are unlikely to recanalize spontaneously, and outcome following persistent occlusion is poor. PCC has been used to reverse warfarin-associated coagulopathy prior to tPA in animal models [3] and may reduce secondary hemorrhagic transformation [4]. Recombinant factor VIIa has been used in similar situations in humans [5], but carries a greater thrombotic risk [6] and is less effective for hemostasis [7], making PCC a potentially favorable option.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".