Risk of thromboembolic events after protocolized warfarin reversal with 3-factor prothrombin complex concentrate and factor VIIa

Cassie A. Barton, Nathan B. Johnson, Jon Case, Bruce Warden, Darrel Hughes, Jason Zimmerman, Gregory Roberti, Wesley D. McMillian, Martin Schreiber

    Research output: Contribution to journalArticle

    14 Citations (Scopus)

    Abstract

    Bleeding events and life-threatening hemorrhage are the most feared complications of warfarin therapy. Prompt anticoagulant reversal aimed at replacement of vitamin K-dependent clotting factors is essential to promote hemostasis. A retrospective cohort study of warfarin-treated patients experiencing a life-threatening hemorrhage treated with an institution-specific warfarin reversal protocol (postimplementation group) and those who received the prior standard of care (preimplementation group) was performed. The reversal protocol included vitamin K, 3-factor prothrombin complex concentrate, and recombinant factor VIIa. Demographic and clinical information, anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded. A total of 227 patients were included in final analysis, 109 in the preimplementation group and 118 in the postimplementation group. Baseline patient characteristics were similar in both groups, with the exception of higher average Sequential Organ Failure Assessment scores in the postimplementation group (P =.0005). The most common indication for anticoagulation reversal was intraparenchymal hemorrhage. Prereversal international normalized ratios (INRs) were similar in both groups. Attainment of INR normalization to less than 1.4 was higher, and rebound INR was lower in the postimplementation group (P

    Original languageEnglish (US)
    Pages (from-to)1562-1566
    Number of pages5
    JournalAmerican Journal of Emergency Medicine
    Volume33
    Issue number11
    DOIs
    StatePublished - Nov 1 2015

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    Factor VIIa
    Warfarin
    International Normalized Ratio
    Hemorrhage
    Anticoagulants
    Organ Dysfunction Scores
    Vitamin K 3
    Blood Coagulation Factors
    Vitamin K
    Standard of Care
    Hemostasis
    Cohort Studies
    Retrospective Studies
    Demography
    prothrombin complex concentrates
    Therapeutics

    ASJC Scopus subject areas

    • Emergency Medicine
    • Medicine(all)

    Cite this

    Risk of thromboembolic events after protocolized warfarin reversal with 3-factor prothrombin complex concentrate and factor VIIa. / Barton, Cassie A.; Johnson, Nathan B.; Case, Jon; Warden, Bruce; Hughes, Darrel; Zimmerman, Jason; Roberti, Gregory; McMillian, Wesley D.; Schreiber, Martin.

    In: American Journal of Emergency Medicine, Vol. 33, No. 11, 01.11.2015, p. 1562-1566.

    Research output: Contribution to journalArticle

    Barton, Cassie A. ; Johnson, Nathan B. ; Case, Jon ; Warden, Bruce ; Hughes, Darrel ; Zimmerman, Jason ; Roberti, Gregory ; McMillian, Wesley D. ; Schreiber, Martin. / Risk of thromboembolic events after protocolized warfarin reversal with 3-factor prothrombin complex concentrate and factor VIIa. In: American Journal of Emergency Medicine. 2015 ; Vol. 33, No. 11. pp. 1562-1566.
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