A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy

Khorsand, Nakisa; Kooistra, H.S.; Hest, Reinier M. van; Veeger, Nic; Meijer, Karina

doi:10.1016/j.thromres.2014.11.019

Cited by 50 publications

(34 citation statements)

References 41 publications

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“…Historically, clinical trials of hemostasis have had limitations. A systematic review [4] that included 28 prospective studies on prothrombin complex concentrate (PCC) efficacy showed that 10 studies [10][11][12][13][14][15][16][17][18][19] lacked any hemostatic outcome parameter and used only a surrogate laboratory parameter. In nine studies [20][21][22][23][24][25][26][27][28], bleeding cessation as an effective outcome parameter was included, but without specific definition.…”

Section: Discussionmentioning

confidence: 99%

Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH

Khorsand

Majeed

Sarode

et al. 2016

Journal of Thrombosis and Haemostasis

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Section: Discussionmentioning

confidence: 99%

Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH

Khorsand

Majeed

Sarode

et al. 2016

Journal of Thrombosis and Haemostasis

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“…This was emphasized by Khorsand et al . in their systematic review . They identified three studies without a specific protocol, with the largest only having 54% success in reaching the target INR, potentially owing to a delay between diagnosis and infusion of PCC .…”

Section: Discussionmentioning

confidence: 99%

“…Other dosing strategies are based on weight alone or fixed doses . Few studies compare dosing strategies ; however, no strategy is clearly superior.…”

Section: Introductionmentioning

confidence: 99%

Prothrombin complex concentrate for emergent reversal of warfarin: an international survey of hospital protocols

et al. 2017

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For emergent warfarin reversal, four-factor prothrombin complex concentrates (4FPCCs) are recommended by many international guidelines. We surveyed international clinical sites including members of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Most sites have emergent warfarin reversal protocols (53% use PCC, 25% use PCC+ plasma and 2% use plasma alone); however, variation between adjusted dosing and fixed dosing was observed.

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“…Regardless of whether fixed dosing or weight-based dosing is utilized, medical centers should have a predefined VKA reversal protocol in place to minimize delays in treatment. 20 …”

Section: F-pcc Dosingmentioning

confidence: 99%

Four-factor prothrombin complex concentrates: effectiveness in the reversal of anticoagulation

Gavva¹,

Reddy²,

Sarode³

2017

IJCTM

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Vitamin K antagonists (VKAs) continue to be the most commonly prescribed class of oral anticoagulants worldwide for the treatment and prevention of venous or arterial thromboembolic events (TEEs). While VKAs are effective at reducing the incidence of TEEs, the risk of major bleeding remains significant. In patients taking VKAs and presenting with clinically significant bleeding or undergoing an emergent procedure, a rapid, effective, and safe reversal agent is required. Available options for the reversal of VKAs include plasma, vitamin K, 3-factor prothrombin complex concentrate (3F-PCC), or 4-factor prothrombin complex concentrate (4F-PCC). Herein, we review the growing evidence that supports using 4F-PCC over both plasma and 3F-PCC for emergent VKA reversal. We also discuss the various dosing options and safety profile of 4F-PCC. In addition, we summarize the limited data available for 4F-PCC in reversing the effects of direct oral anticoagulants and the management of other coagulopathic bleeding.

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A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy

Cited by 50 publications

References 41 publications

Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH

Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH

Prothrombin complex concentrate for emergent reversal of warfarin: an international survey of hospital protocols

Four-factor prothrombin complex concentrates: effectiveness in the reversal of anticoagulation

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