Protocolized warfarin reversal with 4-factor prothrombin complex concentrate versus 3-factor prothrombin complex concentrate with recombinant factor VIIa

Cassie A. Barton, Marissa Hom, Nathan B. Johnson, Jon Case, Ran Ran, Martin Schreiber

    Research output: Contribution to journalArticlepeer-review

    6 Scopus citations

    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.

    Original languageEnglish (US)
    JournalAmerican Journal of Surgery
    DOIs
    StateAccepted/In press - Jan 1 2018

    Keywords

    • Anticoagulation
    • Prothrombin complex concentrate
    • Recombinant factor VIIa
    • Reversal
    • Warfarin

    ASJC Scopus subject areas

    • Surgery

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