Emergency reversal of anticoagulation: The real use of prothrombin complex concentrates

Desmettre, T.; Dubart, Alain-Eric; Capellier, Gilles; Fanara, Benoît; Puyraveau, Marc; Kepka, Sabrina; Coquart, Jérémy; Sheppard, Frances; Tazarourte, Karim

doi:10.1016/j.thromres.2012.05.029

Cited by 37 publications

(28 citation statements)

References 38 publications

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“…This pattern is consistent with a recent study that also examined the use of prothrombin complex concentrate in the reversal of warfarin-induced anticoagulation. 15 However, more patients in the plasma group received treatment for intracranial hemorrhage, whereas more patients in the Octaplex group received treatment before a procedure. Table 4 shows the incidence of each adverse event type observed in the 2 groups.…”

Section: Resultsmentioning

confidence: 99%

“…9,11,[17][18][19] However, most studies on this subject are small retrospective case series that do not have a comparison group of other reversal agents such as frozen plasma, and a recent publication that examined 256 cases of reversal of warfarin-induced anticoagulation with prothrombin complex concentrate found no incidence of a thromboembolic event. 15 Additionally, there is some thought that the risk of a patient having a thrombotic adverse event may be based on an underlying inherent risk of thrombogenesis and may not be caused entirely by the administration of prothrombin complex concentrate.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

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Outcomes of Urgent Warfarin Reversal With Frozen Plasma Versus Prothrombin Complex Concentrate in the Emergency Department

et al. 2013

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Backround-Physicians reverse patients' warfarin anticoagulation with frozen plasma or prothrombin complex concentrate.Our objective was to determine adverse event frequency after urgent reversal with frozen plasma versus the prothrombin complex concentrate Octaplex. Methods and Results-This natural before-after retrospective cohort study in 2 tertiary care emergency departments compared anticoagulation reversal with frozen plasma (September 2006-August 2008 and with Octaplex (September 2008-August 2010, without other system changes. We included adult patients on warfarin with an international normalized ratio ≥1.5 who received frozen plasma or Octaplex. Our primary outcome was serious adverse events (death, ischemic stroke, myocardial infarction, heart failure, venous thromboembolism, or peripheral arterial thromboembolism) within 7 days. Secondary outcomes included time to international normalized ratio reversal, hospital length of stay, and red blood cells transfused within 48 hours. We included 149 patients receiving frozen plasma and 165 receiving Octaplex. The incidence of serious adverse events for the frozen plasma group was 19.5% compared with 9.7% for the Octaplex group (P=0.014; relative risk, 2.0; 95% confidence interval, 1.1-3.5). This remained significant after adjustment for baseline history and reason for treatment (P=0.038; adjusted relative risk, 1.85; 95% confidence interval, 1.03-3.3) in multivariable regression analysis. Median international normalized ratio reversal was 11.8 hours with frozen plasma and 5.7 hours with Octaplex (P<0.0001). Mean red cell transfusion was 3.2 with frozen plasma and 1.4 with Octaplex (P<0.0001). Conclusions-Octaplex Hickey et al Complications From Octaplex Versus FFP 361The objective of this study is to compare the efficacy and safety of frozen plasma with that of Octaplex, the available 4-factor prothrombin complex concentrate, in our emergency departments (EDs) during the study period. Specifically, we examine adverse effects, time to INR reversal, hospital length of stay, and red cell transfusion requirements. Methods Design and SettingThis retrospective cohort study was conducted using health records of patients who were treated with frozen plasma or Octaplex for emergency reversal of warfarin anticoagulation therapy in 2 tertiary EDs at our institution, which see a total of ≈120 000 ED visits per year. We compared patients who received frozen plasma over a 2-year period before the introduction of Octaplex in September 2008 with those who received Octaplex over an equivalent time period after September 2008. The treatments for both groups were given or started in the ED. The dose of Octaplex administered during the study period was governed by the department of Transfusion Medicine. A standard dose of 1500 IU was administered to patients with intracranial hemorrhage, and a dose of 1000 IU was used for all other patients. This study was approved by our institution's research ethics board. Study PopulationWe included patients who were ≥18 years of age, were ...

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Section: Resultsmentioning

confidence: 99%

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Outcomes of Urgent Warfarin Reversal With Frozen Plasma Versus Prothrombin Complex Concentrate in the Emergency Department

et al. 2013

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“…En Europa, aproximadamente 1% de la población está recibiendo actualmente tratamiento con anticoagulantes orales con antagonistas de la vitamina K; esta proporción se incrementará debido al envejecimiento de la población y debido al incremento en la incidencia de enfermedades cardiovasculares relacionadas con la edad que requieren anticoagulación oral, tales como fibrilación auricular, trombosis o reemplazo de válvula aórtica (8).…”

Section: Discussionunclassified

Uso de complejo de protrombina en sangrado digestivo bajo en el paciente crítico anticoagulado. Reporte de caso

Mulett-Vásquez¹,

Marín-Marmolejo²,

Marín-Uribe

2017

Rev Med Hered

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Se presenta el caso de un varón de 66 años en post-operatorio de cirugía de Bentall y reemplazo de válvula aórtica por prótesis metálica, anticoagulación con warfarina, que presenta un episodio de sangrado digestivo bajo secundario a colitis isquémica localizada con INR elevado, sufriendo descompensación hemodinámica. Se realizó tratamiento con concentrado de protrombina humana con adecuada respuesta.

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“…Pour ces deux CCP, 1 ml de produit correspond à 25 UI/kg de facteur IX. Le traitement administré était considéré comme conforme aux recommandations si les doses de CCP utilisées étaient ≥ 20 IU/kg et la vitamine K ≥ 5 mg. Bien qu'aucun délai de temps ne soit spécifié, autre que la notion de réversion la plus rapide possible, nous avons considéré d'après les délais moyens de réversion des études antérieu-res, qu'un traitement administré dans les 8 h suivant l'admission du patient était un critère de bonne pratique [5,16].…”

Section: Méthodes Patients Et Procéduresunclassified

Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study)

Tazarourte

Riou

Tremey

et al. 2014

Ann. Fr. Med. Urgence

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Emergency reversal of anticoagulation: The real use of prothrombin complex concentrates

Cited by 37 publications

References 38 publications

Outcomes of Urgent Warfarin Reversal With Frozen Plasma Versus Prothrombin Complex Concentrate in the Emergency Department

Outcomes of Urgent Warfarin Reversal With Frozen Plasma Versus Prothrombin Complex Concentrate in the Emergency Department

Uso de complejo de protrombina en sangrado digestivo bajo en el paciente crítico anticoagulado. Reporte de caso

Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study)

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