A low fixed dose of prothrombin complex concentrate is cost effective in emergency reversal of vitamin K antagonists

Khorsand, Nakisa; Giepmans, Lisette; Meijer, Karina; Hest, Reinier M. van; Veeger, Nic J. G. M.

doi:10.3324/haematol.2013.085043

Cited by 13 publications

(5 citation statements)

References 4 publications

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“…Patients in the fixed dose cohort received PCC a median of 30 min more quickly (Khorsand et al , ). Fixed doses of PCC have also been shown to be cost‐effective (Khorsand et al , ).…”

Section: Resultsmentioning

confidence: 99%

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg⁻¹: results of the RAPID study

Appleby

Groarke

Crowley

et al. 2016

Transfusion Medicine

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“…Patients in the fixed dose cohort received PCC a median of 30 min more quickly (Khorsand et al , ). Fixed doses of PCC have also been shown to be cost‐effective (Khorsand et al , ).…”

Section: Resultsmentioning

confidence: 99%

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg⁻¹: results of the RAPID study

Appleby

Groarke

Crowley

et al. 2016

Transfusion Medicine

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“…Indeed, most of the studies identified in our literature search are retrospective and observational in nature. While limited, current literature generally supports fixed dosing, 12 , 22 , 28 , 74 with rationale centered on the critical time saved by eliminating weight- and INR-based calculations, and the potential cost-effectiveness of a fixed-dosing approach. 41 , 74 A comprehensive review of fixed dosing studies published from the earliest available date in PubMed through 2018, with doses ranging from 200 to 2000 IU, supported a fixed-dose strategy of 1000–1500 IU.…”

Section: Discussionmentioning

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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“…Time is an important factor impacting outcomes, as sooner administration may speed reversal and potentially reduce hemorrhage size and decrease mortality . Furthermore, lower doses used with fixed dosing can result in cost savings, expand availability to rural and community hospitals, and hypothetically decrease thromboembolic risk . The purpose of this narrative review was to evaluate the efficacy and safety of various fixed‐dose strategies of 4F‐PCC for emergent VKA reversal and to assess limitations of the existing literature.…”

Section: F‐pcc Product Compositionmentioning

confidence: 99%

Fixed‐Dose Four‐Factor Prothrombin Complex Concentrate for Vitamin K Antagonist Reversal: Does One Dose Fit All?

2019

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Four-factor prothrombin complex concentrate (4F-PCC) has emerged as the preferred option for emergent reversal of vitamin K antagonists (VKAs); however, the optimal dosing strategy is unknown.Although several studies have attempted to determine the optimal dose of 4F-PCC using a variety of dosing regimens, no dosing strategy has been found to be superior. Many of these studies have evaluated a low, fixed dose of 4F-PCC rather than individualized dosing as recommended in product labeling. The purpose of this review was to evaluate the efficacy and safety of various fixed-dose strategies of 4F-PCC for emergent VKA reversal and to assess limitations of the existing literature. A search of the PubMed database was performed from the earliest available date through 2018 for relevant articles describing fixed-dose 4F-PCC for VKA reversal. Reference lists of relevant articles were also manually reviewed. Most currently available studies are primarily observational and heterogeneous in design. A very low fixed dose of 500 IU is likely inadequate for successful VKA reversal, but increased fixed doses of 1000-1500 IU have found some degree of success and may be considered for VKA reversal. However, many of these studies consistently identified a trend toward international normalized ratio (INR) reversal failure in patients presenting with high baseline INR values or intracranial hemorrhage, suggesting that higher 4F-PCC doses are needed in these patients. Available studies are underpowered to determine whether a dose-dependent association with thrombotic risk exists. Additional large, randomized studies are needed to determine the optimal dosing strategy and ascertain the role for fixed-dose 4F-PCC. KEY WORDS prothrombin complex concentrates, warfarin, hemorrhage, hemostasis.

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A low fixed dose of prothrombin complex concentrate is cost effective in emergency reversal of vitamin K antagonists

Cited by 13 publications

References 4 publications

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg⁻¹: results of the RAPID study

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg⁻¹: results of the RAPID study

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

Fixed‐Dose Four‐Factor Prothrombin Complex Concentrate for Vitamin K Antagonist Reversal: Does One Dose Fit All?

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A low fixed dose of prothrombin complex concentrate is cost effective in emergency reversal of vitamin K antagonists

Cited by 13 publications

References 4 publications

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg−1: results of the RAPID study

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg−1: results of the RAPID study

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

Fixed‐Dose Four‐Factor Prothrombin Complex Concentrate for Vitamin K Antagonist Reversal: Does One Dose Fit All?

Contact Info

Product

Resources

About

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg⁻¹: results of the RAPID study

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg⁻¹: results of the RAPID study