Study Objectives Current neurocritical care guidelines recommend 50 IU/kg four‐factor prothrombin complex concentrate (4PCC) for factor Xa inhibitor (FXaI) reversal in intracranial hemorrhage (ICH) based on few clinical studies conducted among non‐ICH subjects. Two recent studies suggest that low‐dose (25 IU/kg) 4PCC may be similar to 50 IU/kg in reversal of FXaI in ICH, and both 25 and 50 IU/kg doses are used in clinical practice for this indication. To our knowledge, no studies have directly compared 25 IU/kg versus 50 IU/kg 4PCC for FXaI reversal in ICH. The purpose of this study is to determine whether there is a difference in hemostatic efficacy between 25 IU/kg versus 50 IU/kg 4PCC for FXaI reversal in ICH. Design This multicenter, retrospective cohort study was performed in five hospitals in central Texas from November 2013 to December 2019. Data Source Patients were identified with a medication use report of 4PCC and were classified in the low‐ or standard‐dose group based on whether the 25 IU/kg or 50 IU/kg dose was received, respectively. Patients A total of 93 patients were included (25 IU/kg, n = 62; 50 IU/kg, n = 31). Measurements and Main Results There was no difference in hemostatic efficacy between groups (82.3% low dose vs. 83.9% standard dose, p = 0.846). No differences were identified in‐hospital mortality, length of stay, thrombotic events, or the need for surgery or additional blood products between groups. Conclusion For the reversal of FXaI in ICH, a 25 IU/kg dose may be an effective alternative to 50 IU/kg 4PCC dosing.

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Introduction Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Institutions have implemented pulmonary embolism response teams (PERT) to hasten clinical decision making and therapeutic interventions. The extent to which critical care pharmacists are included in PERTs is not known. Although improved outcomes with pharmacist involvement in other emergency response teams (e.g., stroke teams) is well described, literature surrounding the impact of pharmacist inclusion in PERTs is limited. The objective was to evaluate if direct pharmacist inclusion in a PERT resulted in reduced time to systemic thrombolysis from time of medication order release in appropriate PE candidates. Methods This was a retrospective, observational study of patients with submassive or massive PE who received systemic thrombolysis at a large academic medical center. Patients were divided into two groups based on if they received systemic thrombolysis before or after the intervention. This intervention was the addition of a pharmacist to the PERT with emphasis on early communication between the PERT pharmacist and other stakeholders at time of PERT activation, and a revised thrombolytic preparation workflow emphasizing bedside preparation by the pharmacist. The primary outcome was time to administration of thrombolytic from time of medication order release. Results Thirty‐four patients were included. Median time to thrombolytic administration was reduced in the post‐intervention group compared to the pre‐intervention group (23 min [14.8–42] vs. 54 min [42.8–69], p = 0.007). Bleeding events were not different between groups. Time to resumption of systemic anticoagulation after systemic thrombolysis was greater in the post‐intervention group. Conclusion Inclusion of a pharmacist in the PERT at this institution significantly reduced time to administration of systemic thrombolysis from time of medication order release in appropriate PE candidates. Larger studies should be conducted to expand upon and confirm these findings.