Case Series of Four-Factor Prothrombin Complex Concentrate for Warfarin Reversal Before Heart Transplantation

Nuckles, K.B.; Pratt, Joseph H.; Cameron, Chad M.; Ingemi, Amanda I.

doi:10.1016/j.transproceed.2015.02.008

Cited by 19 publications

(11 citation statements)

References 2 publications

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“…Recently, it has been shown that 3‐F PCC may significantly reduce the use of FFP for warfarin reversal before heart transplant; however, the evidence was not as robust for 4‐F PCC. In other series, 4‐F PCC has also been demonstrated to efficiently reduce INR, and lead to less volume of product delivered, when compared to FFP for warfarin reversal before heart transplantation . This study was limited in several respects.…”

Section: Discussionmentioning

confidence: 99%

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Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation

et al. 2017

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Section: Discussionmentioning

confidence: 99%

“…In other series, 4-F PCC has also been demonstrated to efficiently reduce INR, and lead to less volume of product delivered, when compared to FFP for warfarin reversal before heart transplantation. 12 This study was limited in several respects. The two groups were not contemporaneous.…”

Section: Discussionmentioning

confidence: 99%

Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation

et al. 2017

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“…16,24 In patients requiring more extensive surgery (e.g., heart transplantation, neurosurgery), this time period ranged from 2.5–5.2 hours. 22,23,36…”

Section: Resultsmentioning

confidence: 99%

“…67 International normalized ratio reduction to <1.5 was achieved in all four patients in a small case series of patients undergoing heart transplantation; however, the average time to achieve this was 2.45 hours (still within the recommended 2–3-hour window between dosing and incision). 36…”

Section: Resultsmentioning

confidence: 99%

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal

et al. 2018

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Vitamin K antagonist therapy is associated with an increased bleeding risk, and clinicians often reverse anticoagulation in patients who require emergency surgical procedures. Current guidelines for rapid anticoagulation reversal for emergency surgery recommend four-factor prothrombin complex concentrate and vitamin K coadministration. The authors reviewed the current evidence on prothrombin complex concentrate treatment for vitamin K antagonist reversal in the perioperative setting, focusing on comparative studies and in the context of intracranial hemorrhage and cardiac surgery. The authors searched Cochrane Library and PubMed between January 2008 and December 2017 and retrieved 423 English-language papers, which they then screened for relevance to the perioperative setting; they identified 36 papers to include in this review. Prothrombin complex concentrate therapy was consistently shown to reduce international normalized ratio rapidly and control bleeding effectively. In comparative studies with plasma, prothrombin complex concentrate use was associated with a greater proportion of patients achieving target international normalized ratios rapidly, with improved hemostasis. No differences in thromboembolic event rates were seen between prothrombin complex concentrate and plasma, with prothrombin complex concentrate also demonstrating a lower risk of fluid overload events. Overall, the studies the authors reviewed support current recommendations favoring prothrombin complex concentrate therapy in patients requiring vitamin K antagonist reversal before emergency surgery.

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“…70 More recently, with the approval of Kcentra ® , 4-factor PCCs have been utilized for warfarin reversal prior to heart transplantation, providing a reduction in total volume of blood products needed, without reported thromboembolic complications. 71 Similar strategies have been utilized for other types of solid organ transplantation. The introduction of the DOACs makes utilization of these recommendations difficult and ineffective, as discussed below.…”

Section: Management Of Doacs At Time Of Transplantation Surgerymentioning

confidence: 99%

Direct oral anticoagulant considerations in solid organ transplantation: A review

Salerno

Tsapepas

Papachristos

et al. 2016

Clinical Transplantation

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For more than 60 years, warfarin was the only oral anticoagulation agent available for use in the United States. In many recent clinical trials, several direct oral anticoagulants (DOACs) demonstrated similar efficacy with an equal or superior safety profile, with some other notable benefits. The DOACs have lower inter- and intrapatient variability, much shorter half-lives, and less known drug-drug and drug-food interactions as compared to warfarin. Despite these demonstrated benefits, the use of DOACs has not gained uniform acceptance because of lack of supportive data in special patient populations, including recipients of solid organ transplants maintained on immunosuppression. This review describes the properties of several novel DOACs including their pharmacology and mechanisms of action as they relate to use among solid organ transplant recipients. We have particularly focused on (i) dosing in patients with impaired renal and hepatic function; (ii) considerations for drug-drug interactions with immunosuppressive medications; and (iii) management of the anticoagulated patients at the time of unplanned surgery. The risks and benefits of the use of DOACs in solid organ transplant recipients should be carefully evaluated prior to the introduction of these agents in this highly distinct patient population.

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Case Series of Four-Factor Prothrombin Complex Concentrate for Warfarin Reversal Before Heart Transplantation

Cited by 19 publications

References 2 publications

Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation

Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal

Direct oral anticoagulant considerations in solid organ transplantation: A review

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