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Introduction: Patients treated with direct Xa inhibitors may require urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is common; however, it is based on limited experience in healthy volunteers. Objective: To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery and evaluate its efficacy and safety. Methods: This was a retrospective study in 2 tertiary hospitals. Bleeding was evaluated based on surgical reports, hemoglobin drop, and the use of blood products or additional PCC during 48 h. Safety measures were thrombotic complications and 30-day mortality. Results: Sixty-two patients aged 80.7 ± 9 years, treated with apixaban (39.63%) or rivaroxaban (23.37%), received PCC before an urgent surgery/procedure. Most underwent abdominal operation (61%), orthopedic surgery (13%), or transhepatic cholecystostomy insertion (10%). Bleeding during surgery was reported in 3 patients (5%), no patient required additional PCC, and 16 patients (26%) received packed cells (median: 1 unit, range: 1–5). The 30-day mortality and thrombosis rates were 21% (n = 13) and 3% (n = 2), respectively. The cause of death was related to the primary disease, most commonly sepsis. No patient died due to bleeding/thrombosis. Conclusions: Our results support the use of PCC to achieve hemostasis in patients treated with Xa inhibitors prior to an urgent surgery.

Introduction: The safety of neuro-axial anaesthesia (epidural/spinal) at labour of women with partial factor XI (FXI) deficiency is uncertain. Although FXI deficiency is frequent in Ashkenazi Jews, it is not routinely measured before labour. Our institute serves a large Ashkenazi population. We assumed that 10% of them have undiagnosed FXI deficiency. Aim: Assess the incidence, bleeding tendency and coagulation status among Jewish Ashkenazi women with FXI deficiency that underwent neuro-axial anaesthesia at delivery. Methods: Jewish Ashkenazi women who underwent neuro-axial anaesthesia at labour completed the SSC ISTH bleeding assessment tool (BAT) and had blood drawn for coagulation tests, FXI and thrombin generation after labour. Estimation for 10 years was calculated from the 1-year sample. Results: We recruited 261 women during 12 months. Among them, 39 (15%) had FXI deficiency (<70%) with median FXI levels of 63% (range: 33%-70%). Around 50% of them underwent amniocentesis in the current pregnancy and prior neuro-axial anaesthesia with no bleeding complications. BAT score and thrombin generation did not differ between women regardless of FXI status. aPTT was longer in women with partial FXI deficiency (median-28.6 sec vs 26.3 sec, P < .001, Table 2), although within the normal range in all women. No bleeding complications after neuro-axial anaesthesia at delivery were reported in our centre in the last decade though, and according to our estimation, at least 2150 women had partial FXI deficiency. Conclusions: A significant number of Jewish Ashkenazi women with undiagnosed partial FXI deficiency undergo neuro-axial anaesthesia at labour without bleeding complications.

There is a high incidence of venous thromboembolic complications in patients with beta thalassemia .Recently, a high incidence of asymptomatic multiple silent cerebral infarcts, presumably of arterial origin, were demonstrated in patients with beta thalassemia major (TM) and intermedia. The etiology remains unclear. Endothelial progenitor cells (EPCs) derive from the bone marrow and contribute to regeneration of endothelial damage. We hypothesized that the change in EPCs contributes to the vascular events in patients with TM and that patients have high markers for arterial thromboembolism. Study aim: To assess the change in the number and function of EPCs in TM patients. Methods: Blood samples were drawn from adult patients with TM before blood transfusion and from healthy volunteers. EPCs were isolated from peripheral mononuclear cells by using a Ficoll density-gradient centrifugation. EPCs' levels were detected by flow cytometry, namely by co-expression of VEGFR-2 in CD34 or CD133 positive cells. EPCs were cultured for 7 days after which functional properties were evaluated by: their capacity to form colonies using light microscopy (a colony forming unit (CFU) defined as a cluster of at least 100 flat cells surrounding a cluster of rounded cells) as well as by using a viability assay (using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay). The adhesion molecule P- selectin and the chemokine SDF1 were measured by using Elisa kits according to the manufacturer instructions. Results: Thirty five patients (median age 35 range 27-47y) and 15 healthy volunteers (median age 34.5 range 30-50y) were included. Lower levels of CD34/VEGFR-2 cells and a trend towards CD133/ VEGFR-2 cells were observed in TM patients (Figure 1A). Viability of EPCs and their ability to perform colonies were markedly reduced in TM patients compared to controls; mean MTT 0.05± 0.05 in TM vs. 0.23±0.08 (p<0.01), median number of CFU = 0, range 0-3 in TM vs. 4, range 1-6 in controls (p<0.001), (a representative picture, Figure 1b). SDF1a and P selectin levels were significantly higher in TM compared to healthy volunteers (p=0.05 and P<0.01 respectively). Conclusions: Our results suggest that patients with TM have reduced number and function of EPCs. This may contribute to the silent cerebral infarcts and hypercoagulable state in thalassemia. Furthermore, SDF1a and P selectin, both markers for coronary artery disease were higher in TM. Further studies are planned to establish the possible role of other cytokines in this process. Disclosures Spectre: Pfizer: Honoraria; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Boeringer ingelheim: Honoraria; Bayer: Membership on an entity's Board of Directors or advisory committees.

Introduction: Patients treated with direct Xa inhibitors may require an urgent surgery. A reversal agent for Xa inhibitors was recently approved for major bleeding but not prior to urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is a common practice; however, it is based on limited experience in healthy volunteers. Objective: To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery/procecdure and evaluate its efficacy and safety. Methods: A retrospective study in two tertiary hospitals. Bleeding was evaluated by surgical reports, hemoglobin drop and use of packed red blood cells or additional PCC during 48h. Safety measures were thrombotic complications and 30-day mortality. Results: Sixty-two patients, aged 80.7±9, received PCC prior to urgent invasive procedures ;39 (63%) received apixaban and 23( 37%) rivaroxaban. Ninety percent of them received anticoagulation due to atrial fibrillation. Most urgent procedures were abdominal surgery (61%), orthopedic surgery (13%) or transhepatic cholecystostomy insertion (10%). Mean dose of PCC was 26.6±8 U/kg. Fourteen patients (23%) received 1 gram of tranexamic acid. Bleeding was reported by surgeons in 3(5%) patients and no patient required additional PCC. Sixteen (26%) patients received packed cells (median 1 unit, range 1-5). Thirty day mortality and thrombosis were 13(21%) and 2(3%) respectively. Cause of death was related to the primary disease or sepsis. No patient died due to bleeding/thrombosis. Conclusions: PCC is safe and effective for the reversal of Xa inhibitors prior to an urgent surgery/procedure. Disclosures No relevant conflicts of interest to declare.