PSY81 PERCEPTIONS ABOUT 'RAPID' WARFARIN REVERSAL WITH FRESH FROZEN PLASMA TO REDUCE THE INR: A NOVEL SURVEY METHODOLOGY

Abstract

BACKGROUND: With the increasing use of warfarin anticoagulation, a better understanding of urgent warfarin reversal-related patient care events may improve patient outcomes and control healthcare costs. STUDY DESIGN: A total of 48 adult and pediatric trauma centers were contacted in a double-blinded fashion to participate in a novel, direct-to-provider survey. Participants were asked to provide aggregate information about patients receiving fresh-frozen plasma (FFP) for urgent warfarin reversal. RESULTS: Twenty-five nurses from 18 centers provided information. Perceptions of time needed to infuse FFP (mean 4.4 hrs from triage time; 95% CI 1.17.6 hrs) are consistent with published values. In contrast, average perceptions of time needed for initial international normalized ratio (INR) reversal using FFP (mean 6.1 hrs; 95% CI 3.0-9.1 hrs) underestimate published values by 14 to 26 hrs. Subgroup analysis suggests that FFP unit volume and co-administration of factor concentrates may account for such inconsistency with published values. Healthcare providers perceived that relatively little cumulative time lapses (1.6 hrs, on the average) for completing the first FFP infusion. By contrast, there was substantial reported time (an additional 2.8 hrs, on the average) needed to complete subsequent FFP infusions, amounting to 46% of all perceived time lapsing for initial INR normalization. CONCLUSIONS: Healthcare providers may have inaccurate perceptions of the time required for initial INR normalization with FFP. Volume of FFP and co-administration of factor concentrates may influence these perceptions. Subsequent-to-first FFP dose infusion time accounts for ~50% of perceived INR normalization time. Delineating when there will be prolonged time to adequate INR reversal following FFP may improve treatment practices when urgent warfarin reversal is required.