Abstract
IntroductionProthrombin complex concentrate (PCC) and recombinant Factor VIIa (rFVIIa) have been used for emergent reversal of warfarin anticoagulation. Few clinical studies have compared these agents in warfarin reversal. We compared warfarin reversal in patients who received either 3 factor PCC (PCC3) or low-dose rFVIIa (LDrFVIIa) for reversal of warfarin anticoagulation.MethodsData were collected from medical charts of patients who received at least one dose of PCC3 (20 units/kg) or LDrFVIIa (1000 or 1200 mcg) for emergent warfarin reversal from August 2007 to October 2011. The primary end-points were achievement of an INR 1.5 or less for efficacy and thromboembolic events for safety.ResultsSeventy-four PCC3 and 32 LDrFVIIa patients were analyzed. Baseline demographics, reason for warfarin reversal, and initial INR were equivalent. There was no difference in the use of vitamin K or fresh frozen plasma. More LDrFVIIa patients achieved an INR of 1.5 or less (71.9% vs. 33.8%, p =0.001). The follow-up INR was lower after LDrFVIIa (1.25 vs. 1.75, p < 0.05) and the percent change in INR was larger after LDrFVIIa (54.1% vs. 38.8%, p = 0.002). There was no difference in the number of thromboembolic events (2 LDrFVIIa vs. 5 PCC3, p = 1.00), mortality, length of hospital stay, or cost.ConclusionsBased on achieving a goal INR of 1.5 or less, LDrFVIIa was more likely than PCC3 to reverse warfarin anticoagulation. Thromboembolic events were equivalent in patients receiving PCC3 and LDrFVIIa.
Highlights
Prothrombin complex concentrate (PCC) and recombinant Factor VIIa have been used for emergent reversal of warfarin anticoagulation
We reviewed the charts of patients who required emergent reversal of warfarin anticoagulation and who received either PCC as a 3 factor product (PCC3) or LDrFVIIa to compare the safety and efficacy of these coagulation factor products
The groups were similar with regards to the percentage of patients receiving vitamin K (77.0% 3 factor prothrombin complex concentrate recombinant Factor VIIa (rFVIIa) (PCC3) vs. 68.8% LDrFVIIa, p = 0.37) or fresh frozen plasma (FFP) (66.2% PCC3 vs. 65.6% LDrFVIIa p = 0.95), and the number FFP units administered (2[0-4] PCC3 vs. 2[0-4] LDrFVIIa, p = 0.75) (Table 3)
Summary
Prothrombin complex concentrate (PCC) and recombinant Factor VIIa (rFVIIa) have been used for emergent reversal of warfarin anticoagulation. As the population continues to age, the number of patients receiving warfarin is Patients who suffer severe or life-threatening bleeding complications during warfarin anticoagulation require rapid normalization of their coagulation status in an attempt to minimize bleeding and the associated morbidity. This is achieved by transfusion of fresh frozen plasma (FFP) to provide functional coagulation factors and administering vitamin K. Both strategies require significant time to normalize the patient’s INR (median time > 8–32 hours for FFP and > 24 hours for vitamin K) [3,4,5,6,7,8,9]
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