A narrative review concludes that eptacog may be a potential alternative or adjunct to standard therapy with fresh-frozen plasma and vitamin K in patients with warfarin-induced intracranial bleeding.

Intracranial haemorrhage (ICH) is a serious condition and will be exacerbated by warfarin and related anticoagulant drugs. Prompt reversal of anticoagulation is essential to allow surgical procedures to be carried out if necessary: administration of fresh-frozen plasma and vitamin K is the current standard, however eptacog may be a possible alternative as it rapidly affects the INR and is easily administered. The authors review the limited published evidence for eptacog in this situation, which is restricted to case reports, case series, and retrospective cohort studies.

Based on the evidence available, the authors conclude that eptacog may be useful in warfarin-associated ICH. Given the limited data, however, randomised controlled trials are needed to clarify its place in treatment. The drug is associated with an increased risk of thromboembolic complications, thus patients should be screened for increased thromboembolic risk before receiving it.

[Editor’s note: eptacog is not licensed for this use.]