275 Prothrombin Complex Concentrate Use in a Rural Health Care Network

Abstract

Study ObjectivesReversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods such as fresh frozen plasma (FFP). In many rural facilities the availability of PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal.MethodsThis was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) from outside hospital admission. Active warfarin prescription, EMS transfer to the tertiary facility, and receipt of anticoagulation reversal between January 2012 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Time to event analysis was conducted to compare mean INR reversal times. Propensity score matching was used to match patients in each arm and Chi-square analysis compared variables across groups.ResultsAfter data collection and review, 165 patients were analyzed. There were 44 patients transferred before implementation of the PCC4 exchange program and 121 after. The mean duration to INR reversal was significantly shorter for patients post-exchange (19.03 hours) compared to pre-exchange (38.98 hours) (p=0.0104). There was no significant difference in 30-day mortality between the groups.ConclusionIn rural hospitals, increasing availability of PCC4 using a medication exchange program significantly reduces time to INR reversal in warfarin patients.No, authors do not have interests to disclose Study ObjectivesReversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods such as fresh frozen plasma (FFP). In many rural facilities the availability of PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal. Reversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods such as fresh frozen plasma (FFP). In many rural facilities the availability of PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal. MethodsThis was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) from outside hospital admission. Active warfarin prescription, EMS transfer to the tertiary facility, and receipt of anticoagulation reversal between January 2012 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Time to event analysis was conducted to compare mean INR reversal times. Propensity score matching was used to match patients in each arm and Chi-square analysis compared variables across groups. This was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) from outside hospital admission. Active warfarin prescription, EMS transfer to the tertiary facility, and receipt of anticoagulation reversal between January 2012 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Time to event analysis was conducted to compare mean INR reversal times. Propensity score matching was used to match patients in each arm and Chi-square analysis compared variables across groups. ResultsAfter data collection and review, 165 patients were analyzed. There were 44 patients transferred before implementation of the PCC4 exchange program and 121 after. The mean duration to INR reversal was significantly shorter for patients post-exchange (19.03 hours) compared to pre-exchange (38.98 hours) (p=0.0104). There was no significant difference in 30-day mortality between the groups. After data collection and review, 165 patients were analyzed. There were 44 patients transferred before implementation of the PCC4 exchange program and 121 after. The mean duration to INR reversal was significantly shorter for patients post-exchange (19.03 hours) compared to pre-exchange (38.98 hours) (p=0.0104). There was no significant difference in 30-day mortality between the groups. ConclusionIn rural hospitals, increasing availability of PCC4 using a medication exchange program significantly reduces time to INR reversal in warfarin patients.No, authors do not have interests to disclose In rural hospitals, increasing availability of PCC4 using a medication exchange program significantly reduces time to INR reversal in warfarin patients.