Comparative hemostatic efficacy of 4F-PCC in patients with intracranial hemorrhage on factor Xa inhibitors versus warfarin.

OBJECTIVE: Patients experiencing an intracranial hemorrhage (ICH) on oral anticoagulants often require rapid reversal. This study evaluated patients taking factor Xa inhibitors or warfarin that received reversal with 4-factor prothrombin complex concentrate (4F-PCC) for an ICH. The objective of the study was to determine if the efficacy of 4F-PCC for the reversal of factor Xa inhibitors is noninferior to its use in warfarin reversal in patients with ICH. METHODS: This was a retrospective, single center, noninferiority trial. Patients presenting to the emergency department with ICH were divided into two cohorts: those taking factor Xa inhibitors versus those taking warfarin. In each cohort, patients received anticoagulation reversal with weight-based 4F-PCC. The primary endpoint was hemostatic efficacy defined as ≤20% expansion in hematoma volume on repeat computed tomography imaging. A pre-specified noninferiority margin of -10% was selected to evaluate the difference between groups for the primary endpoint. RESULTS: A total of 221 patients were included in the study (factor Xa inhibitors, n = 87; warfarin, n = 134). Effective hemostasis was achieved in 70 patients (81%) on factor Xa inhibitors compared to 111 patients (83%) on warfarin, (-2.4% difference, [95% confidence interval, -12.87 to 8.12]; p = 0.654). There was no statistically significant difference between groups with regards to the primary outcome; however, the use of 4F-PCC in factor Xa inhibitor reversal was not noninferior when compared to 4F-PCC use for warfarin reversal. Hospital length of stay and discharge disposition were similar between cohorts. CONCLUSIONS: The efficacy of 4F-PCC in reversing factor Xa inhibitor-related ICH compared to warfarin-related ICH was not significantly different between groups; however, these results did not prove noninferiority. Further study is warranted to delineate 4F-PCC's role in reversing factor Xa inhibitors in patients with ICH.

Upcoming American College of Radiology prostate MRI designation launching: what to expect.

The use of prostate MRI for prostate cancer evaluation continues to rise and ensuring minimum quality standards across practices will enable optimal diagnostic accuracy and thus, patient care. The American College of Radiology has been working on quality standards to meet Prostate MRI Designated Center, which is expected to launch in late 2020. We discuss the background of the American College of Radiology Prostate MRI working group's effort and summarize the criteria for Prostate MRI Designation.

Imaging of the cerebellopontine angle.

Pathologic processes within the cerebellopontine angle (CPA) may present because of mass effect on local structures or on the pons or cerebellum. MR imaging is superior to CT for evaluation of the complete extent of a CPA mass and for characterization of its likely nature. MR is also superior to CT for the detection of leptomeningeal processes. Arriving at a short list of differential diagnoses requires a methodical approach, keeping in mind the location, signal, diffusion, and enhancement characteristics of the lesions. Advanced MR imaging techniques, such as magnetic resonance spectroscopy, are not usually needed routinely but may aid in the differential diagnosis when presented with atypical masses.

Bamboo splinter: ultrasound localization.

Ultrasound was used to identify and localize a 2-cm hyperechoic bamboo splinter in the wrist of a patient with persistent symptoms, 1 month after the initial injury, following an initial negative workup by clinical examinations and X-ray.