Safety of a Four-factor Prothrombin Complex Concentrate Versus Plasma for Vitamin K Antagonist Reversal: An Integrated Analysis of Two Phase IIIb Clinical Trials.

Autor: Milling TJ Jr; Seton Clinical Research Institute, Dell University of Texas Medical School, Dell Children's Medical Center, University Medical Center at Brackenridge, Austin, TX., Refaai MA; University of Rochester Medicine, Rochester, NY., Sarode R; UT Southwestern Medical Center, Dallas, TX., Lewis B; St. Joseph Regional Health Center, Bryan, Texas A&M Health Science Center, College Station, TX., Mangione A; CSL Behring, King of Prussia, PA., Durn BL; CSL Behring, King of Prussia, PA., Harman A; CSL Behring, King of Prussia, PA., Lee ML; UCLA School of Public Health, Los Angeles, CA., Goldstein JN; Massachusetts General Hospital, Boston, MA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2016 Apr; Vol. 23 (4), pp. 466-75. Date of Electronic Publication: 2016 Mar 21.
DOI: 10.1111/acem.12911
Abstrakt: Objectives: Clinicians often need to rapidly reverse vitamin K antagonists (VKAs) in the setting of major hemorrhage or urgent need for surgery. Little is known about the safety profile of the traditional reversal agent, plasma, or the newly approved agent, four-factor prothrombin complex concentrate (4F-PCC), in a randomized setting. This is an integrated analysis of safety data from two clinical trials that evaluated 4F-PCC versus plasma for the treatment of patients requiring rapid VKA reversal for acute major bleeding or prior to an urgent surgical/invasive procedure.
Methods: This descriptive analysis comprised adverse event (AE) data from two phase IIIb, randomized, controlled trials. The bleeding and surgical studies were performed across 36 and 33 sites, respectively, in nine countries, with the integrated analysis comprising 388 patients (4F-PCC, n = 191; plasma, n = 197) aged ≥ 18 years, who required VKA reversal due to major bleeding or prior to an urgent surgical/invasive procedure. Patients received either 4F-PCC, containing nonactivated factors II, VII, IX, and X and proteins C and S (Beriplex/Kcentra, CSL Behring) or plasma, both dosed according to baseline international normalized ratio and body weight. Patients were also to receive vitamin K1. AEs and serious AEs (SAEs) were assessed up to days 10 and 45, respectively.
Results: The proportion of patients with AEs (4F-PCC, 115/191 [60.2%]; plasma, 124/197 [62.9%]) and SAEs (4F-PCC, 54/191 [28.3%]; plasma, 49/197 [24.9%]) was similar between groups. The proportion of patients with thromboembolic events was also similar between groups (4F-PCC, 14/191 [7.3%]; plasma, 14/197 [7.1%]). There were 13 (6.8%) deaths in the 4F-PCC group and 13 (6.6%) in the plasma group. Fluid overload events occurred in more patients in the plasma group than the 4F-PCC group (25 [12.7%] and 9 [4.7%], respectively).
Conclusions: These safety data represent the largest controlled assessment of a 4F-PCC to date. For patients requiring urgent VKA reversal, 4F-PCC had a safety profile similar to that of plasma (AEs, SAEs, thromboembolic events, and deaths), but was associated with fewer fluid overload events.
(© 2016 by the Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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