We aim to describe our experience with the four-factor prothrombin complex concentrates (4F-PCC) Kcentra at differing doses in patients with liver cirrhosis requiring emergent hemostasis in the setting of major or life-threatening bleeding. An automated query of patients who received Kcentra between January 2014 and March 2016 was performed. Patients who had clinically significant bleeding and received Kcentra for treatment of coagulopathy of chronic liver disease (CCLD) were included in the study. Baseline patient demographics, administration indication, pertinent laboratory values, and other reversal therapies were collected. Four patients met inclusion for analysis. One patient presented with hemopericardium, cardiac tamponade, and shock, and 3 patients presented with intracranial hemorrhage. Each patient experienced an improvement in international normalized ratio (INR) and at least a period of clinical hemostasis after Kcentra administration without complications referable to Kcentra. Kcentra may be a safe, rapid, and effective treatment option for hemorrhagic emergencies associated with CCLD. Further research is needed to determine the ideal monitoring and dosing regimen for use in CCLD.

replacement or repair, or CABG surgery. Ages ranged from 23-88 yr (mean 62 yr). The mean baseline vitamin D level was 17.5 ng/mL. Dosing regimens varied widely and ranged from ergocalciferol 400 units daily to 50,000 units daily, with the most common being 50,000 units weekly. The mean duration of therapy was 16 days (range 2-116 days) and the mean follow-up level was 25.6 ng/mL. Of those patients with a follow-up vitamin D level, only 34.8% (n=8) achieved a level >30 ng/mL (lower limit of normal) and no patients exceeded the upper limit of normal (100 ng/mL). For patients who achieved a vitamin D level of >30 ng/ mL, the majority (50%) were on a dose of 50,000 units daily, with a duration ranging 10-37 days. No hypercalcemia was observed. Conclusions: In a cardiac surgery population, the majority of patients did not reach a normal serum vitamin D level using standard dietary doses of vitamin D. The dosing regimens in patients who reached a normal serum level suggest that high dose vitamin D is effective. This warrants further study and ongoing evaluation of this regimen during patient care.

No abstract