Comparison of 3-Factor Versus 4-Factor Prothrombin Complex Concentrate With Regard to Warfarin Reversal, Blood Product Use, and Costs
| Autor: | Daniel H. Jarrell, Richard A. Cosgrove, Asad E. Patanwala, James M. Camamo, Christopher J Edwards, Jessica DeAngelo |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Cost-Benefit Analysis Blood Component Transfusion Hemorrhage macromolecular substances 030204 cardiovascular system & hematology Gastroenterology Hemostatics 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Blood product Internal medicine medicine Humans Pharmacology (medical) Platelet 030212 general & internal medicine International Normalized Ratio Aged Retrospective Studies Pharmacology Aged 80 and over Factor VII business.industry Warfarin Anticoagulants Retrospective cohort study General Medicine Off-Label Use Middle Aged Prothrombin complex concentrate Blood Coagulation Factors United States Treatment Outcome chemistry Coagulation Cohort Practice Guidelines as Topic bacteria Female business medicine.drug |
| Zdroj: | American journal of therapeutics. 25(3) |
| ISSN: | 1536-3686 |
| Popis: | BACKGROUND Prothrombin complex concentrates (PCCs) are drug products containing varying amounts of vitamin K-dependent coagulation factors II, VII, IX, and X. The evidence comparing 3-factor PCC (3-PCC) versus 4-factor PCC (4-PCC) for warfarin reversal is conflicting. It has been hypothesized that 3-PCC may be less effective than 4-PCC because of relatively lower factor VII content. STUDY QUESTION The primary objective of this study was to compare international normalized ratio (INR) reversal between 3-PCC and 4-factor PCC (4-PCC) in warfarin-treated patients. The secondary objectives include comparing blood product use, total reversal costs, and cost-effectiveness between the groups. STUDY DESIGN This was a retrospective cohort study conducted in 2 affiliated, academic institutions in the United States. Consecutive adult patients who received 3-PCC or 4-PCC for warfarin reversal were included. MEASURES AND OUTCOMES The primary outcome was adequate INR reversal defined as a final INR ≤1.5. Secondary outcomes were the utilization of plasma, red blood cells and platelets, reversal costs, and the cost-effectiveness ratio. RESULTS There were 89 patients who were included in the overall cohort (3-PCC = 57, 4-PCC = 32). Adequate INR reversal occurred less commonly with 3-PCC (45.6%) compared with 4-PCC (87.5%) (P < 0.001). There was no significant difference in the proportion of patients who received plasma (32% vs. 28%, P = 0.813), red blood cells (37% vs. 47%, P = 0.377), or platelets (16% vs. 28%, P = 0.180) between the 3-PCC and 4-PCC groups, respectively. The median reversal cost of 3-PCC ($3663) was lower than 4-PCC ($5105) (P = 0.001). The cost-effective ratio favored 4-PCC ($5105/87.5% = $5834) compared with 3-PCC ($3663/45.6% = $8033). CONCLUSIONS Four-PCC was more effective than 3-PCC with regard to INR reversal in patients taking warfarin, but blood product use was similar. Although 4-PCC is associated with increased reversal costs, it may be cost-effective in terms of INR reversal. |
| Databáze: | OpenAIRE |
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