Prothrombin Complex Concentrate Versus Standard Therapies for INR Reversal in Trauma Patients Receiving Warfarin

Chapman, Scott A; Irwin, Eric D.; Beal, Alan; Kulinski, Nichole M; Hutson, Katherine E; Thorson, Melissa

doi:10.1345/aph.1p605

Cited by 69 publications

(48 citation statements)

References 22 publications

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“…[18][19][20][21] Conclusions that can be drawn from these studies are limited, however, because of their observational nature and the lack of standardization of the time after PCC administration until measurement of the INR. In most studies of three-factor PCC for warfarin reversal, PCC was used in addition to FFP, which could reduce FFP dosing requirements.…”

Section: Urgent Warfarin Reversalmentioning

confidence: 99%

Pharmacologic interventions for reversing the effects of oral anticoagulants

Kalus

2013

American Journal of Health-System Pharmacy

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Section: Urgent Warfarin Reversalmentioning

confidence: 99%

Pharmacologic interventions for reversing the effects of oral anticoagulants

Kalus

2013

American Journal of Health-System Pharmacy

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“…[26][27][28][29] of PCC for warfarin reversal. Six studies [22][23][24][26][27][28] specifically assessed the efficacy of PCC in traumatic or spontaneous intracranial hemorrhage, whereas 2 studies [25,29] focused on reversal of supratherapeutic INR. Boulis and colleagues [22] was an open-label randomized trial conducted at a single institution that compared the time and rate of warfarin reversal in patients with traumatic intracranial bleeding who were treated with 3-factor PCCs or FFP.…”

Section: Reversal Of Warfarin Anticoagulationmentioning

confidence: 99%

“…The retrospective studies comparing PCC to matched historical controls [26][27][28][29] demonstrated reduced subsequent intracerebral hematoma expansion [26,27]-albeit without major improvements in function-as well as quicker achievement of INR target [27][28][29]. Safety outcomes were not reported in 2 studies [26,27].…”

Section: Efficacy and Safety Outcomes In Reversal Of Warfarin Anticoamentioning

confidence: 99%

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Lin

Murphy

Tran

2013

Transfusion Medicine Reviews

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The use of prothrombin complex concentrates (PCCs) and fibrinogen concentrates (FIBCs) to achieve hemostasis in the perioperative setting as alternatives to allogeneic blood products remains controversial. To examine the efficacy and safety of PCCs and FIBCs, we conducted a systematic review-in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement-to compare the use of these transfusion alternatives in bleeding surgical patients. We performed a literature search of English articles published between July 1997 and July 2012 in MEDLINE via PubMed, The Cochrane Library, and CINAHL. Five randomized trials and 15 nonrandomized studies with a comparator group were included in the final review. Studies were sorted into 1 of the following 3 clinical settings: cardiac surgery, non-cardiac surgery, and reversal of warfarin anticoagulation. Risk of bias was assessed using the Cochrane risk of bias tool. With the exception of 2 randomized controlled trials, the existing body of literature on the use of PCCs and FIBCs in the perioperative setting was assessed to have a high degree of methodological bias. Overall, prospective studies in the cardiac surgery grouping suggested that patients receiving FIBC and/or PCCs required less allogeneic blood transfusion and had less chest tube drainage. In studies of warfarin reversal, PCCs more rapidly corrected the International Normalized Ratio compared to plasma; however, in the setting of intracranial hemorrhage, functional outcomes were poor regardless of the reversal strategy. With regards to safety outcomes, reporting was not uniform and raises concerns of underreporting. Adequately powered, methodologically sound trials would be required for more definitive conclusions to be drawn about the efficacy of PCCs and FIBC over conventional blood components for the treatment of perioperative coagulopathy in bleeding patients.

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“…The results of one retrospective analysis demonstrated that in trauma patients receiving warfarin, the addition of PCC treatment to FFP and vitamin K treatment yielded a more rapid INR reversal; however, no clear improvement in clinical outcomes was noted [51].…”

Section: Traumamentioning

confidence: 99%

Prothrombin complex concentrates in emergency bleeding disorders

Rodgers

2012

American J Hematol

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The use of prothrombin complex concentrates (PCCs), a heterogeneous combination of coagulation factors and counterbalancing inhibitor components, has broadened in recent years beyond single‐factor replacement in conditions such as hemophilia B, to encompass emergency reversal of anticoagulation secondary to oral vitamin K antagonists, ie, warfarin therapy. PCCs also have been studied in other bleeding disorders, such as surgery‐related and trauma‐related bleeding. This review provides an updated examination of the differences among PCC formulations, their potential role in the management of bleeding disorders, and the primary safety issues affecting their use. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.

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Prothrombin Complex Concentrate Versus Standard Therapies for INR Reversal in Trauma Patients Receiving Warfarin

Abstract: PCC, when added to FFP and vitamin K, resulted in a more rapid time to reversal of the INR.

Cited by 69 publications

References 22 publications

Pharmacologic interventions for reversing the effects of oral anticoagulants

Pharmacologic interventions for reversing the effects of oral anticoagulants

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Prothrombin complex concentrates in emergency bleeding disorders

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