Recombinant activated factor VII and prothrombin complex concentrates have different effects on bleeding and arterial thrombosis in the haemodiluted rabbit

Saché, Frédéric Le; Bonniec, Bernard Le; Gaussem, Pascale; Dizier, Blandine; Tagzirt, Madjid; Godiér, Anne; Emmerich, Joseph; Samama, Charles‐Marc

doi:10.1093/bja/aer450

Cited by 5 publications

(1 citation statement)

References 34 publications

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“…reported successful cessation of bleeding in four of five patients treated with PCC . In animal bleeding models, recombinant activated factor VII and PCC improved laboratory measures of coagulation after treatment with rivaroxaban but failed to reduce blood loss …”

Section: Management Of the Bleeding Patient On Noacmentioning

confidence: 99%

New oral anticoagulants: clinical indications, monitoring and treatment of acute bleeding complications

Fenger-Eriksen

Münster

Grove

2014

Acta Anaesthesiol Scand

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New oral anticoagulants like the direct thrombin inhibitor, dabigatran (Pradaxa®), and factor Xa-inhibitors, rivaroxaban (Xarelto®) and apixaban (Eliquis®) are available for prophylaxis and treatment of thromboembolic disease. They are emerging alternatives to warfarin and provide equal or better clinical outcome together with reduced need for routine monitoring. Methods for measuring drug concentrations are available, although a correlation between plasma drug concentrations and the risk of bleeding has not been firmly established. Standard laboratory measures like prothrombin time and activated partial thromboplastin time are not sensitive enough to detect thrombin or factor Xa inhibition provided by new oral anticoagulants. Thus, these standard tests may only be used as a crude estimation of the actual anticoagulation status. Further challenges regarding patients receiving new oral anticoagulants who presents with major bleeding or need for emergency surgery pose a unique problem. No established agents are clinically available to reverse the anticoagulant effect, although preclinical data report prothrombin complex concentrate as more efficient than fresh frozen plasma or other prohaemostatic agents. This review summaries current knowledge on approved new oral anticoagulants and discusses clinical aspects of monitoring, with particular focus on the management of the bleeding patient.

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Section: Management Of the Bleeding Patient On Noacmentioning

confidence: 99%

New oral anticoagulants: clinical indications, monitoring and treatment of acute bleeding complications

Fenger-Eriksen

Münster

Grove

2014

Acta Anaesthesiol Scand

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Retrospective study of rFVIIa, 4‐factor PCC, and a rFVIIa and 3‐factor PCC combination in improving bleeding outcomes in the warfarin and non‐warfarin patient

2016

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In case of severe bleeding, the physician must rapidly and effectively halt bleeding without the risk of thromboembolic complications. Despite widespread use, no study has directly compared recombinant activated factor VII (rFVIIa), the rFVIIa and 3‐factor prothrombin complex concentrate (PCC) combination (“combination”), and 4‐factor PCC on their effectiveness in improving patient outcomes. This study examined the medical records of 299 patients, 65.2% on warfarin prior to admission, who received these hemostatic agents and were admitted to an ICU or through the emergency department at Oregon Health & Science University. Mortality, length of stay, change in international normalized ratio (INR), plasma use, and number of thromboembolic complications were used to assess effectiveness. In patients receiving warfarin, the combination group had the greatest decrease in INR as well as lowest overall INR, but experienced a higher number of clotting complications, while the rFVIIa group used the most plasma. Non‐warfarin patients in the combination group had the shortest length of stay among survivors, but the rFVIIa group had the lowest mortality. Based on this data, it may be prudent to further study the use of rFVIIa in treating extreme bleeding in the non‐warfarin patient, while this study supports other data that 4‐factor PCC may be the most prudent for the warfarin patient. Am. J. Hematol. 91:705–708, 2016. © 2016 Wiley Periodicals, Inc.

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Medicamentos derivados del plasma: fracciones coagulantes y anticoagulantes

Martin

Samama

2014

EMC - Anestesia-Reanimación

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Recombinant activated factor VII and prothrombin complex concentrates have different effects on bleeding and arterial thrombosis in the haemodiluted rabbit

Abstract: Neither rVIIa nor PCC reduced HS blood loss, whereas they both controlled the bleeding time, without increasing the thrombosis risk.

Cited by 5 publications

References 34 publications

New oral anticoagulants: clinical indications, monitoring and treatment of acute bleeding complications

New oral anticoagulants: clinical indications, monitoring and treatment of acute bleeding complications

Retrospective study of rFVIIa, 4‐factor PCC, and a rFVIIa and 3‐factor PCC combination in improving bleeding outcomes in the warfarin and non‐warfarin patient

Medicamentos derivados del plasma: fracciones coagulantes y anticoagulantes

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