Prothrombin complex concentrate administration through intraosseous access for reversal of rivaroxaban

Means, Laura; Gimbar, Renee Petzel

doi:10.1016/j.ajem.2015.07.057

Cited by 11 publications

(3 citation statements)

References 4 publications

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“…The presented observation broadens the knowledge concerning the administration of haemostatic drugs over IO line. The narrative literature review lists experiments for IO delivery of FVIIa in animal models, 12 as well as cases of 4‐ and 3‐factor prothrombin complex concentrates administrated IO 7,13 …”

Section: What Is New and Conclusionmentioning

confidence: 99%

Successful intraosseous factor VIII application in a haemophilic emergency

et al. 2020

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Section: What Is New and Conclusionmentioning

confidence: 99%

Successful intraosseous factor VIII application in a haemophilic emergency

et al. 2020

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“…Intraosseous administration of Profilnine SD® (factor IX complex [human] [factors II, IIX, X]), a three‐factor prothrombin complex concentrate, was used to promote haemostasis in a patient presenting to the emergency department with bleeding due to rivaroxaban use. A dose of 1490 units was successfully administered to the patient using the IO route without any adverse effects . A single case report details the use of 4F‐PCC given via the IO route for emergent reversal of an intracranial haemorrhage in a patient anticoagulated with warfarin.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Intraosseous administration of 4‐factor prothrombin complex concentrate prior to emergent surgery after receiving apixaban

et al. 2019

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What is known and objective: The 4-factor prothrombin complex concentrate (4F-PCC) may be used to emergently achieve haemostasis in patients on anticoagulation prior to surgery. Limited data exist using the intraosseous route of administration of 4F-PCC in patients taking factor Xa inhibitors. Case description:We describe a case of a 69-year-old female receiving oral apixaban that was successfully administered 4F-PCC using intraosseous access prior to emergent surgery to obtain haemostasis intraoperatively. What is new and conclusion:Intraosseous access may be a viable route of administration for 4F-PCC in patients receiving factor Xa inhibitors to achieve haemostasis when necessary. K E Y W O R D S anticoagulation, apixaban, haemostasis, intraosseous, prothrombin complex concentrate R E FE R E N C E S 1. Sikorska J, Uprichard J. Direct oral anticoagulants: a quick quide. Eur Cardiol. 2017;12(1):40-45. https ://doi.

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“…Results of current trials confirm the feasibility and effectiveness of IO administration of blood products, tranexamic acid, and fibrinogen 6–8 . A case report showed the successful IO administration of prothrombin complex concentrate 9 . Moreover, the reversal of dabigatran using IO idarucizumab in a porcine trauma model has been reported 10 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of ROTEM parameters from venous and intraosseous blood

Wiegele

Hamp

Gratz

et al. 2019

Sci Rep

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Rotational thromboelastometry is recommended to guide haemostatic therapy in trauma-related coagulopathy. In the case of unsuccessful venepuncture, intraosseous access allows immediate administration of drugs and volume replacement. Feasibility of rotational thromboelastometry from intraosseous blood has not yet been investigated in humans. We performed rotational thromboelastometry and standard coagulation assays from intraosseous and intravenous blood samples in 19 volunteers and 4 patients undergoing general anaesthesia. Intraosseous access was performed either at the tibial bone or the proximal humerus. We observed visible clotting in the majority of the intraosseous samples. Only 13% of the probes allowed realization of rotational thromboelastometry. ROTEM parameters are reported as follows: shorter median clotting time (CT) in EXTEM, INTEM, and APTEM (53 vs. 68 s; 140 vs. 154 s; 54 vs. 62.5 s) and smaller median maximal clot firmness (MCF) in EXTEM and APTEM (56 vs. 63 mm; 55 vs. 62 mm) in intraosseous samples. We found no relevant differences in median MCF values in FIBTEM and INTEM (12 vs. 13 mm; 60 vs. 59 mm). Given the difficulties we faced during IO blood sampling in a study setting, we advise against ROTEM measurements out of IO blood for guidance of procoagulant therapy in emergency situations.

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Prothrombin complex concentrate administration through intraosseous access for reversal of rivaroxaban

Cited by 11 publications

References 4 publications

Successful intraosseous factor VIII application in a haemophilic emergency

Successful intraosseous factor VIII application in a haemophilic emergency

Intraosseous administration of 4‐factor prothrombin complex concentrate prior to emergent surgery after receiving apixaban

Comparison of ROTEM parameters from venous and intraosseous blood

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