Evaluation of the Use of Low-Dose 4-Factor Prothrombin Complex Concentrate in the Reversal of Direct Oral Anticoagulants in Bleeding Patients

• Published in: Journal of intensive care medicine Vol. 35; no. 9; p. 903
• Main Authors: Allison, Teresa A, Lin, Pei Jen, Gass, Jennifer A, Chong, Kenneth, Prater, Samuel J, Escobar, Miguel A, Hartman, Heather D
• Format: Journal Article
• Language: English
• Published: United States 01.09.2020
• Subjects: Aged; Anticoagulants - adverse effects; Blood Coagulation Factors - administration & dosage; Critical Care Outcomes; Factor Xa Inhibitors - adverse effects; Female; Hemorrhage - diagnostic imaging; Hemorrhage - drug therapy; Hemostasis - drug effects; Hemostatic Techniques; Hemostatics - administration & dosage; Humans; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; anticoagulants; hemorrhage/drug therapy; hemorrhage/prevention and control; hemostatics/therapeutic use; blood coagulation; prothrombin complex concentrates
• ISSN: 1525-1489
• DOI: 10.1177/0885066618800657

This study investigated the percentage of patients who achieved hemostasis with 4-factor prothrombin complex concentrate (4-factor PCC) 35 U/kg. The primary end point was to determine the effect of 4-factor PCC 35 U/kg on bleeding progression, assessed using computed tomography. This was a retrospective, observational, single-center study conducted in patients with a major bleed admitted to a level 1 trauma center from May 1, 2013, to June 15, 2015, who received 4-factor PCC 35 U/kg for reversal of a direct factor Xa inhibitor taken prior to admission. Thirty-three patients were included in the study, with 31 patients in the final analysis. The mean (standard deviation) age was 73 (14.8) years; 54.5% of patients were female. Of the 33 patients, 13 presented with a traumatic brain injury, 9 with an aneurysmal subarachnoid hemorrhage, 8 with an intracerebral hemorrhage, 1 with a gastrointestinal bleed, 1 with a hematoma with active extravasation, and 1 with an intra-abdominal bleed. The most frequently used direct factor Xa inhibitor was rivaroxaban (81.8%). Overall, 83.8% of patients achieved hemostasis with 4-factor PCC 35 U/kg. Progression of hemorrhage was observed in 4 patients on repeat computed tomography scan and 1 patient had continued surgical bleeding. No thromboembolic events were reported. Low-dose, 4-factor PCC 35 U/kg appeared to produce hemostasis in a majority of the patients. This may be an effective dosing regimen for anticoagulant reversal of factor Xa inhibitors in clinically bleeding patients.