890: Stability of Four-Factor Prothrombin Complex Concentrate After Pneumatic Tubing

Jun, Ah Hyun; Chester, Katleen; Winkler, Anne; Webb, A.K.

doi:10.1097/01.ccm.0000509566.88546.c5

Cited by 1 publication

(1 citation statement)

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“…56 Potential solutions to these barriers include point-of-care INR testing, 48 allowing ED doctors to request and prescribe 4F-PCCs without the hematologist’s prior approval, expediting delivery of 4F-PCC from the blood transfusion service or pharmacy, and adopting pharmacy verification and dispensing of 4F-PCCs. 3,57 –60 Indeed, it was shown that a pharmacist-driven protocol (in which the pharmacist calculated the dose, prepared 4F-PCC and delivered it to the bedside) reduced the administration interval to 35 minutes versus 70 minutes for the blood transfusion service-driven protocol. However, the impact of this reduction on, INR correction/ICH progression was not reported.…”

Section: Resultsmentioning

confidence: 99%

Optimal Dosage and Administration Practices for Vitamin K Antagonist Reversal With 4-Factor Prothrombin Complex Concentrate

Rhoney

Chester

Darsey

2020

Clin Appl Thromb Hemost

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Expert consensus and international guidelines recommend urgent co-administration of vitamin K and 4-factor prothrombin complex concentrates (4F-PCCs) to rapidly reverse VKA-related bleeding. This narrative review examined real-world evidence and strategies to optimize international normalized ratio (INR) reversal, hemostasis, and outcomes in patients receiving 4F-PCC in this setting. Key determinants for success include the appropriate use of alternative dosing and administration strategies, such as fixed dosing and increased infusion speed, adherence to institutional guidelines, and removing significant institutional barriers to reduce time to treatment. In the opinion of authors, minimizing the time to treatment with 4F-PCCs is of paramount importance when treating patients with VKA-related bleeding. Practices that safely and feasibly shorten the time to administration should be included in guidelines for institutions responsible for anticoagulant care, and adhered to in centers that perform invasive procedures on patients receiving VKA therapy. Further studies are required to optimize use of 4F-PCC, particularly in relation to the ideal dosing strategy and the role of INR.

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