744: FIXED-DOSE 4F-PCC IS SUPERIOR TO WEIGHT-BASED DOSING IN DELIVERY TIME AND COST WITH EQUAL REVERSAL

Abstract

Introduction: Patients who suffer an intracranial hemorrhage (ICH) while on anticoagulation have higher mortality than those who are not. 4-factor prothrombin complex (4F-PCC) has become the standard therapy for emergent warfarin reversal and is traditionally dosed based on patient weight and INR. This strategy can lead to increased time before administration. A fixed-dose strategy has been found comparable in efficacy and may reduce the time to delivery. The goal of this study was to evaluate fixed-dose vs weight-based dosing strategies for 4F-PCC time to administration in patients with an ICH. Methods: A retrospective analysis was conducted at a single rural ACS verified Level 2 Trauma center in pts ≥18 y/o on warfarin with ICH who received 4F-PCC. Continuous variables were summarized using mean (±95% CI) and compared using two-tailed tests; p values ≤0.05 were considered statistically significant. Results: A total of 46 ICH pts were reversed by 4F-PCC (Fixed, n=27 and Weight, n=19). Baseline characteristics including admission GCS, ICH type on admit head CT, and baseline INR were statistically equivalent (p>0.05). Total units of 4F-PCC were reduced in the fixed-dose group (1623.3 (95% CI [1515.1, 1731.4]) vs. 2525.1 units, (95% CI [2091.7, 2895.4]); p=0.001) as was dose per kg (19.2 units/kg (95% CI [17.2, 21.2]) vs. 28.9 units/kg (95% CI [24.8, 33.0]); p < 0.001). This resulted in a mean cost saving of $1461 per patient. Eleven percent of patients required additional 4F-PCC (p=0.951). Total time from order to delivery was significantly reduced with the fixed-dose strategy, 28 (95% CI [25, 31]) vs. 43 (95% CI [33, 53]) minutes (p=0.015). Hospital length of stay (LOS), ICU LOS, and mortality were equivalent in groups with similar mechanism (traumatic vs non-traumatic; p>0.05). INR reversal success (INR ≤1.5 after 4F-PCC) was 84.2% vs. 85.2% (p=1.00) and total INR change was also comparable (2.1 vs. 2.4, p=0.68); with no difference in adverse thromboses between groups (p=1.00). Conclusions: A fixed-dosed strategy reduced time to administration of 4F-PCC for warfarin reversal in ICH as compared to a weight-based strategy. There was no increase in LOS, mortality, or need for additional 4F-PCC dosing. This also resulted in significant cost savings.