Faculty Collaboration Database

Emergent reversal of vitamin K antagonists: addressing all the factors. Am J Surg 2016 May;211(5):919-25

Date

04/06/2016

Pubmed ID

27046797

DOI

10.1016/j.amjsurg.2016.02.007

Scopus ID

2-s2.0-84962013729 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

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 M

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 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