Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies

Cartmill, Maria; Dolan, Gayle P.; Byrne, J L; Byrne, Paul

doi:10.1080/02688690050175265

Cited by 192 publications

(14 citation statements)

References 5 publications

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“…Several studies comparing the efficacy of PCCs with human plasma for emergency oral anticoagulant reversal have shown that PCCs provide more effective and more rapid correction of coagulopathy [44-47]. These findings, together with the improved safety profile of today's PCCs, suggest that PCCs should be considered preferable to FFP for emergency oral anticoagulant reversal.…”

Section: Comparing Pccs With Human Plasmamentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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Prothrombin complex concentrates (PCCs) are used mainly for emergency reversal of vitamin K antagonist therapy. Historically, the major drawback with PCCs has been the risk of thrombotic complications. The aims of the present review are to examine thrombotic complications reported with PCCs, and to compare the safety of PCCs with human fresh frozen plasma. The risk of thrombotic complications may be increased by underlying disease, high or frequent PCC dosing, and poorly balanced PCC constituents. The causes of PCC thrombogenicity remain uncertain but accumulating evidence indicates the importance of factor II (prothrombin). With the inclusion of coagulation inhibitors and other manufacturing improvements, today's PCCs may be considered safer than earlier products. PCCs may be considered preferable to fresh frozen plasma for emergency anticoagulant reversal, and this is reflected in the latest British and American guidelines. Care should be taken to avoid excessive substitution with prothrombin, however, and accurate monitoring of patients' coagulation status may allow thrombotic risk to be reduced. The risk of a thrombotic complication due to treatment with PCCs should be weighed against the need for rapid and effective correction of coagulopathy.

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Section: Comparing Pccs With Human Plasmamentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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“…Similarly, in a prospective study 52 of 41 patients requiring rapid reversal of VKA-associated overanticoagulation, 28 of 29 patients treated with 4F PCC showed a complete correction of the INR within 15 minutes (mean INR of 1.3), while 0 of 12 patients treated with FFP corrected within this time frame (mean INR of 2.3). A number of other studies 15,24,49,50,53–58 have confirmed the efficacy of PCCs in the rapid reversal of elevated INRs.…”

Section: Treatment Options For Reversal Of Overanticoagulationmentioning

confidence: 78%

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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“…Despite the increasing use of PCC, including activated PCC, there are no large RCTs to support its use other than in haemophilia [469-471] or for the rapid reversal of the effect of oral vitamin K antagonists [472-474]. In the setting of trauma patients treated with pre-injury warfarin, a retrospective analysis showed that the use of PCC resulted in a more rapid time to reversal of the INR [475-478].…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsA comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.Please see related letter by Morel et alhttp://ccforum.com/content/17/4/442

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Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies

Cited by 192 publications

References 5 publications

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Reversal of Warfarin-Induced Hemorrhage in the Emergency Department

Management of bleeding and coagulopathy following major trauma: an updated European guideline

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