A promising new alternative for the rapid reversal of warfarin coagulopathy in traumatic intracranial hemorrhage

Safaoui, Marian N.; Aazami, Roshanak; Hotz, Heidi; Wilson, Matthew T.; Margulies, Daniel R.

doi:10.1016/j.amjsurg.2008.04.003

Cited by 28 publications

(11 citation statements)

References 29 publications

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“…In our study groups, the incidence of thromboembolic events was equal in both groups. Safaoui et al reported no thromboembolic events in 28 patients receiving 2000 units of PCC3 (Konyne™ or Profilnine™) [26]. In a recent case report a dose of 50 units/kg of PCC for warfarin reversal was associated with fatal intracardiac thrombosis in a patient who had also received 24 micrograms of desmopressin for suspected uremic platelet dysfunction and fifty minutes later underwent pericardiocentesis [27].…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3-Factor Prothrombin Complex Concentrate and Low-Dose Recombinant Factor VIIa for Warfarin Reversal

et al. 2014

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IntroductionProthrombin complex concentrate (PCC) and recombinant Factor VIIa (rFVIIa) have been used for emergent reversal of warfarin anticoagulation. Few clinical studies have compared these agents in warfarin reversal. We compared warfarin reversal in patients who received either 3 factor PCC (PCC3) or low-dose rFVIIa (LDrFVIIa) for reversal of warfarin anticoagulation.MethodsData were collected from medical charts of patients who received at least one dose of PCC3 (20 units/kg) or LDrFVIIa (1000 or 1200 mcg) for emergent warfarin reversal from August 2007 to October 2011. The primary end-points were achievement of an INR 1.5 or less for efficacy and thromboembolic events for safety.ResultsSeventy-four PCC3 and 32 LDrFVIIa patients were analyzed. Baseline demographics, reason for warfarin reversal, and initial INR were equivalent. There was no difference in the use of vitamin K or fresh frozen plasma. More LDrFVIIa patients achieved an INR of 1.5 or less (71.9% vs. 33.8%, p =0.001). The follow-up INR was lower after LDrFVIIa (1.25 vs. 1.75, p < 0.05) and the percent change in INR was larger after LDrFVIIa (54.1% vs. 38.8%, p = 0.002). There was no difference in the number of thromboembolic events (2 LDrFVIIa vs. 5 PCC3, p = 1.00), mortality, length of hospital stay, or cost.ConclusionsBased on achieving a goal INR of 1.5 or less, LDrFVIIa was more likely than PCC3 to reverse warfarin anticoagulation. Thromboembolic events were equivalent in patients receiving PCC3 and LDrFVIIa.

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Section: Discussionmentioning

confidence: 99%

Comparison of 3-Factor Prothrombin Complex Concentrate and Low-Dose Recombinant Factor VIIa for Warfarin Reversal

et al. 2014

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“…Options include vitamin K, FFP, cryoprecipitate, PCCs (a preparation of concentrated forms of clotting factors II, VII, IX, and X that is used specifically to replace the factors that are inactivated by warfarin), factor IX complex, and rFVIIa (Novoseven). 7,11,17 The best approach to warfarin reversal is controversial, and there are few published studies to guide best practice. The general consensus is that major or life-threatening bleeding requires rapid and complete warfarin reversal.…”

Section: Discussionmentioning

confidence: 99%

Dabigatran bleed risk with closed head injuries: are we prepared?

Parra

Zucker

Johnson

et al. 2013

JNS

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The 2006 Annual Report of the National Trauma Data Bank (NTDB), Version 6.0, is an updated analysis of the largest aggregation of trauma registry data that has ever been assembled. The NTDB now contains over 2 million records.This 2006 Annual Report is based on 1,191,215 records from the years [2001][2002][2003][2004][2005]. The NTDB uses a rolling 5-year time frame for the annual analysis in order to focus on the most recent, highest quality data. Prior to analysis, NTDB data are subjected to a quality screening for consistency and validity, as described in Appendix C.The mission of the American College of Surgeons (ACS) Committee on Trauma (COT) is to develop and implement meaningful programs for trauma care. In keeping with this mission, the NTDB is committed to being the principal national repository for trauma center registry data. We estimate that 67% of Level I and 56% of Level II trauma centers in the United States have contributed data to the NTDB.The purpose of this report is to inform the medical community, the public, and decision makers about a wide variety of issues that characterize the current state of care for injured persons in our country. It has implications in many areas including epidemiology, injury control, research, education, acute care, and resource allocation.

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“…Additionally, its high cost for an average patient ($5,542 for an average dose versus $2,205 for the same patient on PCC) and short half-life of 2.5 to 3 hours make it a less favorable candidate with which to treat warfarin-induced coagulopathy. 44 The incidence of thrombotic adverse events associated with rFVIIa is rare, 24.5 per 10 5 infusions, with an elevated risk for cerebrovascular thrombosis. 45 …”

Section: Treatment Options For Reversal Of Overanticoagulationmentioning

confidence: 99%

Reversal of Warfarin-Induced Hemorrhage in the Emergency Department

Zareh¹,

Aj²,

Henderson³

2011

WestJEM

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Warfarin, an oral vitamin K antagonist, is used to prevent arterial and venous thromboembolism in patients suffering from a multitude of diseases. In 2004, 31 million warfarin prescriptions were dispensed in the United States. Warfarin inhibits the activation of the vitamin K–dependent clotting factors (Factors II, VII, IX, and X) and regulatory proteins (proteins C, S, and Z). It is one of the leading drugs implicated in emergency room visits for adverse drug reactions. Annually the frequency of bleeding complications associated with overanticoagulation is 15% to 20%, with fatal bleeds measuring as high as 1% to 3%. The most effective method of warfarin reversal involves the use of Four Factor Prothrombin Complex Concentrate (PCC), which is widely used throughout Europe but is unavailable in the United States. The current therapies available to emergency room physicians in the United States are fresh frozen plasma, recombinant Factor VIIa (rFVIIa), Factor Eight Inhibitory Bypassing Activity, or Three Factor PCC concomitantly administered with vitamin K. We review the advantages and disadvantages of these therapies and recommend Three Factor PCC with small doses of rFVIIa and with vitamin K in life-threatening situations if Four Factor PCC is unavailable.

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A promising new alternative for the rapid reversal of warfarin coagulopathy in traumatic intracranial hemorrhage

Cited by 28 publications

References 29 publications

Comparison of 3-Factor Prothrombin Complex Concentrate and Low-Dose Recombinant Factor VIIa for Warfarin Reversal

Comparison of 3-Factor Prothrombin Complex Concentrate and Low-Dose Recombinant Factor VIIa for Warfarin Reversal

Dabigatran bleed risk with closed head injuries: are we prepared?

Reversal of Warfarin-Induced Hemorrhage in the Emergency Department

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