Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg−1: results of the RAPID study

Autor: M. Crowley, F. A. Wahab, N. Appleby, N. O'Connell, A. M. McCann, E. Groarke, Denis O'Keeffe, L. Egan, Geraldine McMahon, D. O'Donghaile, D. Gough
Rok vydání: 2016
Předmět:
Zdroj: Transfusion Medicine. 27:66-71
ISSN: 0958-7578
Popis: SUMMARYBackground Real-world studies of the emergency reversal of warfarin using 4-factor prothrombin complex concentrate (PCC) report unwarranted delays. The delay to receiving PCC was ≥ 8 h in 46·7% of patients with warfarin-associated bleeding (PWAB) treated with a variable PCC dosing protocol in our retrospective audit. Objective To report the impact of a simplified PCC dosing protocol on the interval to reversal of anticoagulation. Methods We developed a PCC dosing protocol standardising the initial PCC dose and simplifying dosing calculations. Study end points were the proportion of PWAB achieving international normalised ratio (INR) ≤1·5 and treated within 8 h of presentation, respectively. Results Of 17, 15 (88·2%) PWABs achieved a post-treatment INR ≤ 1·5; 14 of 17 (82·4%) PWABs were reversed within 8 h. Median intervals between triage and PCC request and PCC request and start of infusion (administration interval) were 126 min (range 39–520) and 30 min (range 5–100), respectively. Compared with the retrospective cohort, RAPID is associated with an improved administration interval (mean 37·7 vs 76 min, P = 0·031) and the proportion of PWABs treated within 30 min (58·8 vs 6·7%, P = 0·009). Conclusion The RAPID protocol reduces unwarranted delays without compromising efficacy.
Databáze: OpenAIRE
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