Protocolized warfarin reversal with 4-factor prothrombin complex concentrate versus 3-factor prothrombin complex concentrate with recombinant factor VIIa - 25/04/18
, Marissa Hom a , Nathan B. Johnson a , Jon Case a , Ran Ran b , Martin Schreiber c Abstract |
Introduction |
Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal.
Methods |
A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded.
Results |
195 patients were included in final analysis. While baseline demographics were similar between groups, the 3F-PCC group had a longer ICU LOS and higher in-hospital mortality (p < .01, .01).
Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the 3F-PCC group, 0.8 versus 1.3 (p < .01). Significantly more patients experienced thromboembolic complications in the 3F-PCC group than the 4F-PCC group (p < .01). Receipt of rFVIIa was significantly associated with thromboembolic complications.
Discussion |
A 4F PCC reversal strategy is efficacious in INR reversal and provides lower thromboembolic risk as compared to 3F PCC with rFVIIa.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Three factor PCC combined with rFVIIa and four factor PCC were both efficacious at reducing the INR in patients needing emergent warfarin reversal. |
• | Three factor PCC with rFVIIa was associated with a significant thromboembolic risk. |
• | Three factor PCC and rFVIIa in combination should be avoided as a reversal strategy due to the high thromboembolic risk. |
Keywords : Warfarin, Prothrombin complex concentrate, Reversal, Recombinant factor VIIa, Anticoagulation
Plan
Vol 215 - N° 5
P. 775-779 - mai 2018 Retour au numéro
Article précédent
- The Halifax Explosion a century later: Lessons for our time
- Preston L. Carter
- Discussion of “Protocolized warfarin reversal with 4-factor prothrombin complex concentrate versus 3-factor prothrombin complex concentrate with recombinant factor VIIa”
- Rachel Van Dusen
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?