Jan Jahnel

Reversal of warfarin-induced anticoagulation with factor VIIa prior to rt-PA in acute stroke

Thrombolytics for stroke are contraindicated if a patient’s prothrombin time (PT) is above 15. Recombinant factor VII (rVIIa) has been approved for the rapid reversal of warfarin-induced coagulopathy. Since rVIIa can reverse coagulopathy quickly, it might be useful to correct PT elevations in patients who are eligible for thrombolytics. A 71-year-old, right-handed woman with a history of left hemispheric ischemic stroke presented to our emergency department with new onset of left arm and leg weakness, facial droop, visual field blurring, and dysarthria. The symptoms began initially at 9:15 am and en route to the hospital, she became quadriplegic. Upon arrival, the patient was oriented and had mild dysarthria and bilateral facial droop, left greater than right. Strength was 0/5 in all extremities and deep tendon reflexes were 2+ in the right limbs and 1+ in the left. NIH Stroke Scale score was 20. The patient’s previous ischemic …