Emergent reversal of Vitamin K antagonists: Addressing all the factors

David T. Martin, Cassie A. Barton, Christopher Dodgion, Martin Schreiber

    Research output: Contribution to journalArticle

    10 Scopus citations

    Abstract

    Background Reversal of warfarin-induced coagulopathy after traumatic injury may be done exclusively with prothrombin complex concentrates (PCCs). No direct comparisons between different PCC regimens exist to guide clinical decision-making. Our institution has used 2 distinct PCC strategies for warfarin reversal; a 3-Factor PCC (Profilnine) combined with activated Factor VII (3F-PCC+rVIIa), and a 4-Factor PCC (Kcentra) given without additional factor supplementation. Methods Retrospective review of all PCC administrations to trauma patients with acute bleeding who were taking warfarin before injury. Primary endpoints were international normalized ratio (INR) reduction, in-hospital mortality, and diagnosis of deep venous thrombosis (DVT). Results Eighty-seven patients were identified from 2011 to 2015. Fifty-three were treated with 3F-PCC+rVIIa and 34 with 4F-PCC. Patient demographics, injury severity, and presenting laboratory data were similar. The 3F-PCC+rVIIa produced a lower median (IQR) INR postreversal compared with 4F-PCC (.75 (.69, 1.00) vs 1.28 (1.13, 1.36), P

    Original languageEnglish (US)
    Pages (from-to)919-925
    Number of pages7
    JournalAmerican Journal of Surgery
    Volume211
    Issue number5
    DOIs
    StatePublished - May 1 2016

    Keywords

    • Coagulopathy
    • Prothrombin complex concentrates
    • Traumatic hemorrhage
    • Warfarin

    ASJC Scopus subject areas

    • Surgery

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