{"title":"Emergent Reversal of Intracranial Hemorrhage Using 4-Factor Prothrombin Complex Concentrate in a Pediatric Patient.","authors":"Ruchi P Jain, Keri Bicking, Amanda Clouser","doi":"10.1097/MPH.0000000000003261","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulant (DOACs) use for pediatric venous thromboembolism has increased, yet data on reversal strategies using 4-factor prothrombin complex concentrate (4F-PCC) remains limited.</p><p><strong>Observation: </strong>We report the first case of intracranial hemorrhage (ICH) in a patient receiving rivaroxaban who underwent reversal with 4F-PCC. An 11-year-old male with sinusitis complicated by multifocal intracranial abscesses, and superior sagittal sinus thrombus treated with rivaroxaban, was found to have ICH. For urgent craniotomy, rivaroxaban was reversed with 2223 units (∼45 units/kg) 4F-PCC. No thromboembolism occurred within 3 months.</p><p><strong>Conclusion: </strong>This case adds to the limited literature supporting 4F-PCC for DOAC reversal in pediatrics.</p>","PeriodicalId":16693,"journal":{"name":"Journal of Pediatric Hematology/Oncology","volume":" ","pages":"353-357"},"PeriodicalIF":0.9000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Hematology/Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MPH.0000000000003261","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/8/19 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Direct oral anticoagulant (DOACs) use for pediatric venous thromboembolism has increased, yet data on reversal strategies using 4-factor prothrombin complex concentrate (4F-PCC) remains limited.
Observation: We report the first case of intracranial hemorrhage (ICH) in a patient receiving rivaroxaban who underwent reversal with 4F-PCC. An 11-year-old male with sinusitis complicated by multifocal intracranial abscesses, and superior sagittal sinus thrombus treated with rivaroxaban, was found to have ICH. For urgent craniotomy, rivaroxaban was reversed with 2223 units (∼45 units/kg) 4F-PCC. No thromboembolism occurred within 3 months.
Conclusion: This case adds to the limited literature supporting 4F-PCC for DOAC reversal in pediatrics.
期刊介绍：
Journal of Pediatric Hematology/Oncology (JPHO) reports on major advances in the diagnosis and treatment of cancer and blood diseases in children. The journal publishes original research, commentaries, historical insights, and clinical and laboratory observations.
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