Reversal of Warfarin-Associated Major Hemorrhage: Activated Prothrombin Complex Concentrate versus 4-Factor Prothrombin Complex Concentrate
| Autor: | Nicholas Panos, Megan A. Rech, Robert Mokszycki, Rolla T. Sweis, Joshua M. DeMott, Gary D. Peksa, Brian Maynard |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty medicine.drug_class Hemorrhage 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Electronic Health Records Humans International Normalized Ratio Aged Retrospective Studies Aged 80 and over business.industry Warfarin Anticoagulants Thrombosis Retrospective cohort study Hematology Length of Stay Middle Aged Vitamin K antagonist medicine.disease Prothrombin complex concentrate Blood Coagulation Factors Confidence interval Intensive Care Units 030104 developmental biology Cohort Propensity score matching Female Emergency Service Hospital business medicine.drug |
| Zdroj: | Thrombosis and Haemostasis. 120:207-215 |
| ISSN: | 2567-689X 0340-6245 |
| Popis: | Background Warfarin-associated major hemorrhage is frequently treated with prothrombin complex concentrates to correct international normalized ratio (INR). Objective This article aims to investigate the efficacy of activated prothrombin complex concentrate (aPCC) versus 4-factor prothrombin complex concentrate (4PCC) for vitamin K antagonist reversal in patients with warfarin-associated major hemorrhage. Materials and Methods This was a multicenter, retrospective cohort study. Patients included were age ≥ 18 years with pretreatment INR of > 1.5. Exclusion criteria were patients treated for urgent procedures without hemorrhage, treated but not taking warfarin, unavailable INR values, and pregnant patients. Patients were stratified into two groups: aPCC or 4PCC. The primary outcome was achievement of INR ≤ 1.5 at the posttreatment INR sampling. Secondary outcomes focused on thrombotic events and mortality. Results Of 342 patients, 237 patients received aPCC and 105 patients received 4PCC. After 1:1 propensity score matching, 86 patients remained in each group. In the matched cohort, the proportion of patients who achieved target INR ≤ 1.5 was greater with 4PCC (aPCC = 61 [70.9%] vs. 4PCC = 76 [88.4%]; 95% confidence interval [CI] –29.2% to –5.7%) and groups had comparable in-hospital thrombotic events and mortality. In the unmatched cohort, achievement of target INR ≤ 1.5 was greater with 4PCC (aPCC = 151 [63.7%] vs. 4PCC = 92 [87.6%]; 95% CI –32.7% to –15.1%). Conclusion In the treatment of warfarin-associated major hemorrhage, 4PCC compared with aPCC was associated with greater achievement of INR ≤ 1.5 with comparable thrombotic events and mortality. Further controlled studies are needed to confirm these findings and determine the optimal dosing strategy that maximizes efficacy and safety. |
| Databáze: | OpenAIRE |
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