Emergent reversal of vitamin K antagonists: addressing all the factors. Am J Surg 2016 May;211(5):919-25
Date
04/06/2016Pubmed ID
27046797DOI
10.1016/j.amjsurg.2016.02.007Scopus ID
2-s2.0-84962013729 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
BACKGROUND: Reversal of warfarin-induced coagulopathy after traumatic injury may be done exclusively with prothrombin complex concentrates (PCCs). No direct comparisons between different PCC regimens exist to guide clinical decision-making. Our institution has used 2 distinct PCC strategies for warfarin reversal; a 3-Factor PCC (Profilnine) combined with activated Factor VII (3F-PCC+rVIIa), and a 4-Factor PCC (Kcentra) given without additional factor supplementation.
METHODS: Retrospective review of all PCC administrations to trauma patients with acute bleeding who were taking warfarin before injury. Primary endpoints were international normalized ratio (INR) reduction, in-hospital mortality, and diagnosis of deep venous thrombosis (DVT).
RESULTS: Eighty-seven patients were identified from 2011 to 2015. Fifty-three were treated with 3F-PCC+rVIIa and 34 with 4F-PCC. Patient demographics, injury severity, and presenting laboratory data were similar. The 3F-PCC+rVIIa produced a lower median (IQR) INR postreversal compared with 4F-PCC (.75 (.69, 1.00) vs 1.28 (1.13, 1.36), P<.001). Both regimens were able to obtain an INR lower than 1.5 immediately after administration (3F+rVIIA 93.9% vs 4F 97.1%, P =.51). In the 4F-PCC group, there was a significant decrease in the incidence of DVT (2.9% vs 22.6%), P < .01), and a nonsignificant reduction in mortality (2.9% vs 17.0%, P = .08).
CONCLUSIONS: Use of 4F-PCC for warfarin reversal after traumatic hemorrhage is associated with a less severe decrease in INR, a significant reduction in DVT rates and a trend toward reduced mortality when compared with similar patients treated with 3F-PCC+rVIIa.
Author List
Martin DT, Barton CA, Dodgion C, Schreiber MAuthor
Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Blood Coagulation Factors
Chi-Square Distribution
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Combinations
Emergencies
Factor IX
Factor VII
Factor X
Female
Follow-Up Studies
Hemorrhage
Humans
International Normalized Ratio
Male
Middle Aged
Prothrombin
Retrospective Studies
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Treatment Outcome
Vitamin K
Warfarin
Wounds and Injuries