Fixed versus variable dose of prothrombin complex concentrate for counteracting vitamin K antagonist therapy

Abstract

This study suggests that a fixed dose of 1040 IU of F IX may be an effective way to rapidly counteract VKA therapy in our patient population and provides a basis for future research.

An observational, prospective, two-cohort comparison of a fixed versus variable dosing strategy of prothrombin complex concentrate to counteract vitamin K antagonists in 240 bleeding emergencies

“…11 In this study, a trend was observed towards a marginally lower proportion of patients who reached the target International Normalized Rate (INR) after treatment with the fixed dose regimen compared to variable doses. Variable dosing is recommended by the manufacturer and is based on patient weight, baseline INR, and target INR.…”

“…Interestingly, we saw the same trend in difference in mortality rate in our previous pilot study which was performed in one Dutch hospital site when switching from the variable dose regimen to a low fixed dose regime. 11 While bleeding was not a direct cause of death in the majority of patients, it could have a potential prognostic implication as a predictor of poor outcome in clinical assessments. An in depth study has been made of bleeding complications after, for example, bone marrow transplantation.…”

Pharmacologic interventions for reversing the effects of oral anticoagulants

“…[22][23][24][25][26][27][28] In contrast to three-factor PCC products, four-factor PCC products were effective for reducing the INR when used without FFP. The effect of four-factor PCC products on bleeding was similar to that of FFP.…”

A low fixed dose of prothrombin complex concentrate is cost effective in emergency reversal of vitamin K antagonists

“…Interestingly, we did see the same trend in higher mortality rate in the variable PCC dose regimen compared to the low fixed dose regimen in our previous pilot study which was performed on one Dutch hospital site. 4 In summary, our cost analyses showed that a cost reduction in PCC with a low fixed dose strategy did not coincide with a cost increase due to utilization of other treatment options for VKA associated bleedings. Furthermore, by treatment of these bleeding emergencies with a low fixed PCC dose strategy, on average 1634 euros per patient to 2100 euros per successfully treated patient was saved com-pared to a variable dosing strategy.…”