Q: Why administration of rFVIIa without co-administration of Vitamin-K may be deceiving in treatment of warfarin induced intra-cranial-hemorrhage (ICH)?


 Answer: Administration of rFVIIa alone, without co-administration of Vitamin-K, will normalize the INR but will not replace other vitamin K-dependent clotting factors. It corrects only the warfarin-induced reduction in the level of factor VII. Normalization of INR  gives a false sense of security. Also, half life of rFVIIa is only 2-3 hours and Vitamin-K is required for sustained reversal of warfarin.