Comparison of 3-Factor Versus 4-Factor Prothrombin Complex Concentrate With Regard to Warfarin Reversal, Blood Product Use, and Costs

Abstract

Four-PCC was more effective than 3-PCC with regard to INR reversal in patients taking warfarin, but blood product use was similar. Although 4-PCC is associated with increased reversal costs, it may be cost-effective in terms of INR reversal.

Propensity Score Adjusted Comparison of Three-Factor versus Four-Factor Prothrombin Complex Concentrate for Emergent Warfarin Reversal: A Retrospective Cohort Study

“…The proportion of patients who reached the goal INR was higher with PCC4 (87% vs. 31.6%, p < 0.001). Comparisons of PCC3 and PCC4 products for EWR have been done by others (17)(18)(19)(20)(21)(22)(23). Our study is similar to these other studies regarding retrospective design, PCC products compared, and the adult population.…”

“…Given the compositional differences in the PCC products, it is important to know if there are differences in clinical response for effective and safe use of these products. Studies evaluating the comparative effects of PCC3 and PCC4 head-to-head for EWR with the outcome of INR lowering response and/or clinical outcomes are few (17)(18)(19)(20)(21)(22)(23). The inclusion criteria for these studies vary, but all were in adult patients needing reversal of warfarin for bleeding, surgical intervention, and/or trauma associated bleeding.…”

Perioperative management of antithrombotic treatment in children

“…Four‐factor PCC contains thrombin, FVII, FIX, and FX, and protein C and S and should be given if reversal of VKA is required within 4‐6 hours in situations requiring emergency surgery or major hemorrhage. Three‐factor PCC contains significantly less FVII and reverses the INR to a lesser extent, so four‐factor PCC is to be preferred although there are a few countries that do not have access to four‐factor PCC . PCC is currently unlicensed in children and there is limited data upon its use.…”

“…Three-factor PCC contains significantly less FVII and reverses the INR to a lesser extent, so four-factor PCC is to be preferred although there are a few countries that do not have access to four-factor PCC. 28 PCC is currently unlicensed in children and there is limited data upon its use. There is also the potential concern that the risk of thrombosis can be increased after administration of PCC due to the patient's underlying prothrombotic state and the prothrombotic effect of PCC.…”

Comparing Factor Concentrates for Post-Bypass Coagulopathy: Is There One Best Option?

“…7 A similar recent comparison in warfarin-anticoagulated patients revealed that 4-factor PCC was more effective in INR reversal (r 1.5) than 3-factor PCC (87.5% v 45.6%, p o 0.001). 8 While there was no difference in blood product transfusion, 4-factor PCC also was demonstrated to be a more costeffective option. These head-to-head comparisons alone should not be used to determine the one best option, but they should be used to emphasize the important relationship between Factor VII and INR values.…”