Table 1 Protocol for reversal of coagulopathy prior to and following insertion of ICP monitor

I. Coagulation parameters to be achieved prior to procedure:

a. Transfusion of pooled platelets to goal platelet count >50,000/cm³.

b. Transfusion of cryoprecipitate to goal fibrinogen level >100 mg/dL.

II. Immediately before start of procedure:

a. Single dose of desmopressin 0.3mcg/kg IV administered prior to ICP monitor placement.

b. Recombinant Factor VIIa 80mcg/kg IV over 2 to 5 minutes. Following administration of rFVIIa, ICP monitor insertion was performed without repeat laboratory testing to confirm a decrease in the INR.

c. Placement of the ICP monitor within 60 minutes of administration of the rFVIIa dose, clipping and skin preparation to begin within 15–30 minutes of administration of rFVIIa.

d. FFP 10 cc/kg infused at the time of monitor insertion regardless of INR

III. Post-procedure:

Repeat laboratory evaluation every 6 hours and correction of coagulopathy, if safe and feasible, to the following goal parameters for a period of 24 hours following placement of the ICP monitor -

a. Platelet count >50,000/cm³

b. Fibrinogen >100 mg/dL

c. INR ≤1.5

Maintenance of these goals for 24 hours could be omitted if the patient was thought to be at high risk of harm from blood product transfusions