Prothrombin Complex Concentrate before Urgent Surgery in Patients Treated with Rivaroxaban and Apixaban.

Autor:	Barzilai M; Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Kirgner I; Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Steimatzky A; Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel., Salzer Gotler D; Internal Medicine F, Sourasky Medical Center, Tel Aviv, Israel., Belnick Y; Internal Medicine D, Rabin Medical Center, Hasharon Hospital, Petah Tikva, Israel., Shacham-Abulafia A; Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Avivi I; Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Raanani P; Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Yahalom V; Transfusion and Apheresis Service, Rabin Medical Center, Petah Tikva, Israel., Nakav S; Hemostasis Laboratory, Rabin Medical Center, Petah Tikva, Israel., Varon D; Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel., Yussim E; Department of Radiology, Sourasky Medical Center, Tel Aviv, Israel., Bachar GN; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Department of Radiology, Rabin Medical Center, Petah Tikva, Israel., Spectre G; Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel, galia.spectre@gmail.com.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, galia.spectre@gmail.com.
Jazyk:	angličtina
Zdroj:	Acta haematologica [Acta Haematol] 2020; Vol. 143 (3), pp. 266-271. Date of Electronic Publication: 2019 Oct 14.
DOI:	10.1159/000502173
Abstrakt:	Introduction: Patients treated with direct Xa inhibitors may require urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is common; however, it is based on limited experience in healthy volunteers. Objective: To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery and evaluate its efficacy and safety. Methods: This was a retrospective study in 2 tertiary hospitals. Bleeding was evaluated based on surgical reports, hemoglobin drop, and the use of blood products or additional PCC during 48 h. Safety measures were thrombotic complications and 30-day mortality. Results: Sixty-two patients aged 80.7 ± 9 years, treated with apixaban (39.63%) or rivaroxaban (23.37%), received PCC before an urgent surgery/procedure. Most underwent abdominal operation (61%), orthopedic surgery (13%), or transhepatic cholecystostomy insertion (10%). Bleeding during surgery was reported in 3 patients (5%), no patient required additional PCC, and 16 patients (26%) received packed cells (median: 1 unit, range: 1-5). The 30-day mortality and thrombosis rates were 21% (n = 13) and 3% (n = 2), respectively. The cause of death was related to the primary disease, most commonly sepsis. No patient died due to bleeding/thrombosis. Conclusions: Our results support the use of PCC to achieve hemostasis in patients treated with Xa inhibitors prior to an urgent surgery. (© 2019 S. Karger AG, Basel.)
Databáze:	MEDLINE
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