Experiences with an activated 4-factor prothrombin complex concentrate (FEIBA) for reversal of warfarin-related bleeding

Stewart, William S.; Pettit, Herbert

doi:10.1016/j.ajem.2013.05.008

Cited by 25 publications

(21 citation statements)

References 22 publications

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“…Two retrospective studies have evaluated a low‐fixed dose of aPCC for warfarin reversal Both used an aPCC dose of 1000 units for an INR of ≥ 5 and 500 units for an INR of < 5. This is the dose of aPCC used at our institution for VKA‐associated coagulopathy reversal.…”

Section: Introductionmentioning

confidence: 99%

Activated Prothrombin Complex Concentrate versus Plasma for Reversal of Warfarin-Associated Hemorrhage

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Activated Prothrombin Complex Concentrate versus Plasma for Reversal of Warfarin-Associated Hemorrhage

et al. 2016

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“…None of the factors are activated, as opposed to FEIBA. 1,5,6 It is notable that Kcentra has a higher reported range of concentration of protein C than other 4F-PCCs, which suggests a theoretical ''balanced'' safety profile compared to other concentrates, but this has not been proven in any study known to these authors. 7 Also present in Kcentra is heparin, antithrombin, human albumin, sodium chloride, sodium citrate, hydrochloric acid, and sodium hydroxide.…”

Section: Characteristics Of 4f-pccmentioning

confidence: 96%

“…This latter option-the factor ''cocktail''-has been shown to be effective in reducing the international normalized ratio (INR), but puts a patient at an increased risk for thrombosis. 4 It has been shown that the activated 4F-PCC known as factor eight inhibitor bypassing activity (FEIBA, containing factors II, activated VII, IX, and X; Baxter Healthcare Corporation, Westlake Village, California) is useful for reversing the effects of VKA therapy, 5 but this product is approved only for treating hemophiliac patients with factor VIII or factor IX inhibitors who are bleeding or require surgical intervention. 6 Products with an activated factor VII component, such as recombinant fVIIa and FEIBA, also carry an increased risk for thrombosis.…”

Section: Vitamin K Antagonists: Background Andmentioning

confidence: 99%

Clinical Applications of 4-Factor Prothrombin Complex Concentrate: A Practical Pathologist's Perspective

Unold

Tormey²

2014

Archives of Pathology &Amp; Laboratory Medicine

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A 4-factor prothrombin complex concentrate (4F-PCC), containing therapeutic doses of vitamin K-dependent coagulation factors, was recently licensed in the United States for reversal of vitamin K antagonist therapy. However, given the emergence of several oral anticoagulants for which there are no specific reversal agents, and the existence of many other complex bleeding disorders, it is likely that clinicians will seek to use 4F-PCCs for any number of off-label indications. Thus, the goal of this review is to explore practical issues regarding 4F-PCC, with an emphasis on issues relevant to blood bankers and pathologists. Specifically, our aims are to (1) examine the role of 4F-PCC in vitamin K antagonist reversal, (2) review its potential use in the treatment of hemorrhage due to novel oral anticoagulants, and (3) explore potential uses in liver disease, trauma-associated bleeding, and rare coagulopathies. Safety and other practical considerations of 4F-PCCs will also be discussed.

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“…Its off-label use as reversal agent for VKA-induced coagulopathy seems obvious because of its composition (presence of all procoagulant vitamin K-dependent factors, with factor VII in its activated form). The clinical usefulness of activated PCC in emergency reversal of vitamin K antagonists has been demonstrated in a limited number of clinical studies [10,22]. Vitamin K-dependent coagulation proteins.…”

Section: Reversal Of Vitamin K Antagonistsmentioning

confidence: 99%

Prothrombin Complex Concentrate, a General Antidote for Oral Anticoagulation

Brinkman¹

2016

Anticoagulation Therapy

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Prothrombin complex concentrate (PCC) is used for the rapid reversal of vitamin K antagonist (VKA) anticoagulation. PCC is also applicable in situations requiring rapid reversal of anticoagulation by non-vitamin K antagonist direct thrombin and factor Xa inhibitor oral anticoagulants (NOACs), thereby making PCC a general antidote for oral anticoagulation. In this chapter, the composition of different PCC brands is reviewed and a negative effect of heparin supplement in some products is recognized. Mode of action of anticoagulation reversal by PCC is explained. Dosage and clinical efficacy, two closely related issues, are discussed and based on reviewed data recommendations are given that may prohibit too low PCC dosing, especially in NOAC anticoagulation. Use of unsuitable laboratory assays has raised needless controversy as to the applicability of PCC to reverse anticoagulation by NOACs, in particular dabigatran. In this chapter, various laboratory assays are evaluated for their applicability in monitoring reversal of anticoagulation.

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Experiences with an activated 4-factor prothrombin complex concentrate (FEIBA) for reversal of warfarin-related bleeding

Cited by 25 publications

References 22 publications

Activated Prothrombin Complex Concentrate versus Plasma for Reversal of Warfarin-Associated Hemorrhage

Activated Prothrombin Complex Concentrate versus Plasma for Reversal of Warfarin-Associated Hemorrhage

Clinical Applications of 4-Factor Prothrombin Complex Concentrate: A Practical Pathologist's Perspective

Prothrombin Complex Concentrate, a General Antidote for Oral Anticoagulation

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