Prothrombin complex concentrates in emergency bleeding disorders

Rodgers, George M.

doi:10.1002/ajh.23254

Cited by 34 publications

(41 citation statements)

References 38 publications

(62 reference statements)

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“…All PCCs include factors II, IX, and X; however, 4-factor PCCs also contain clinically relevant levels of factor VII and result in a more reliable correction of the INR when compared with 3-factor concentrates. 16 The duration of effect of PCCs is approximately six hours due to the short half-life of factor VII. Octaplex Ò and Beriplex Ò , the PCCs discussed in this module, are the two 4-factor PCCs approved for use in Canada.…”

Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

“…The clinical effect of the two products is similar, and there is no recommendation of one product over the other for reversal of warfarin-induced anticoagulation. 9,16 Nevertheless, there are differences between Octaplex and Beriplex regarding the formulation and virus inactivation as well as the recommended infusion rates (Table 1).…”

Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

“…Therefore, PCCs should not be given to patients with heparin-induced thrombocytopenia (HIT), albeit, there is a lack of clinical evidence that the administration of PCCs leads to the development of HIT. 16 These products may increase the risk of thromboembolism and are not indicated for patients with disseminated intravascular coagulation or a recent history of thrombosis or myocardial infarction. The products should be used with caution in these circumstances and only after a careful assessment of the patient-specific risks and benefits.…”

Section: Contraindicationsmentioning

confidence: 99%

“…Ces derniers entraînent une correction plus fiable du RIN par rapport aux concentrés à 3 facteurs. 16 La durée d'action des CCP est d'environ six heures en raison de la courte demi-vie du facteur VII. L'Octaplex Ò et le Beriplex Ò sont les deux CCP à 4 facteurs approuvés au Canada et ce sont ces CCP dont il sera question dans ce module.…”

Section: Les Concentrés De Complexe Prothrombiqueunclassified

“…L'effet clinique de ces deux produits est semblable, et il n'existe pas de recommandation privilégiant un produit ou l'autre lorsqu'il est question de renverser l'anticoagulation induite par la warfarine. 9,16 Cependant, l'Octaplex Ò et le Beriplex Ò diffèrent en matière de formulation et d'inactivation virale, ainsi qu'en ce qui a trait à leur débit de perfusion (tableau 1).…”

Section: Les Concentrés De Complexe Prothrombiqueunclassified

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Reversal of warfarin anticoagulation for urgent surgical procedures

Curtis

Schweitzer

Vlymen

2015

Can J Anesth/J Can Anesth

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Purpose Patients treated with warfarin for therapeutic anticoagulation present a challenge for the perioperative management of urgent and emergent surgery. Anticoagulation must be reversed prior to most surgical procedures to prevent intraoperative bleeding. The purpose of this module is to review the options for urgent reversal of warfarin anticoagulation and the indications for each reversal agent. Selection of the appropriate agent is important to reduce unnecessary complications of treatment and to achieve optimal reversal of anticoagulation. Principal findings When urgent surgery is required for patients taking warfarin, intravenous vitamin K 1 should be used for procedures that can be delayed for six to 12 hr. Vitamin K 1 results in the activation of existing clotting factors rather than requiring the synthesis of new proteins, which allows for its relatively rapid onset of action. Intravenous vitamin K 1 acts more quickly than oral administration, with reversal of anticoagulation occurring within six to 12 hr vs 18-24 hr, respectively. If surgery cannot be delayed, prothrombin complex concentrates (PCCs) should be given, and intravenous vitamin K 1 should be infused concurrently to ensure sustained reversal of anticoagulation. The duration of action of both PCCs and plasma is six hours due to the short half-life of factor VII. Prothrombin complex concentrates contain small amounts of heparin and are contraindicated in patients with heparin-induced thrombocytopenia. Plasma should be used only if PCCs are unavailable or are contraindicated. Conclusion Reversal of warfarin anticoagulation can be achieved in a safe and timely manner when the appropriate agent is selected and administered correctly. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to: 1. Identify the options for emergency reversal of warfarin anticoagulation; 2. Describe the dose, onset, and duration of action of agents that reverse warfarin anticoagulation; 3. List potential complications and contraindications of agents that reverse warfarin anticoagulation; 4. Choose the optimal agent for emergency reversal of warfarin anticoagulation, considering the timing of the operation and the risks and benefits of each agent.Despite increasing use of novel agents, warfarin remains the most widely prescribed oral anticoagulant in clinical use. A recent analysis of prescribing trends following regulatory approval for the newer agents showed that warfarin still accounted for over 75% of all the oral anticoagulants used. 1 Warfarin is indicated to reduce the risk of thromboembolic events in patients with atrial fibrillation, mechanical heart valves, and deep venous thrombosis, among other indications. Therefore, as the population ages, the use of anticoagulants, including warfarin, is projected to increase substantially.Patients treated with warfarin for therapeutic anticoagulation present a challenge for the perioperative management of urgent and emergent surgery. In order to...

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Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

Section: Contraindicationsmentioning

confidence: 99%

Section: Les Concentrés De Complexe Prothrombiqueunclassified

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Reversal of warfarin anticoagulation for urgent surgical procedures

Curtis

Schweitzer

Vlymen

2015

Can J Anesth/J Can Anesth

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Use and effectiveness of prothrombin complex concentrate in an emergency department: a review of 15 cases

Suzuki

Iwashita

Enokiya

et al. 2015

Acute Medicine & Surgery

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Aim: Hemostatic management of patients on oral anticoagulant therapy with critical bleeding continues to be a major challenge. The present study aimed to validate the efficacy, safety, and optimal dosage of prothrombin complex concentrate for rapidly normalizing elevated international normalized ratio (INR) values and achieving control of hemorrhage at an emergency department in Japan. Methods:We retrospectively collected data from all patients who were treated with PCC at our emergency department between January 2013 and September 2014. We used a commercially available prothrombin complex concentrate.Results: Fifteen patients (male / female, 7/8; average, 71.4 years) received prothrombin complex concentrate (14 for bleeding, including trauma-related bleeding, and one for invasive intervention) without complications. All but one patient received warfarin and the INR value declined in all patients with 500 IU (average, 8.98 IU/kg) prothrombin complex concentrate (average INR value before and after treatment: 2.20 versus 1.26). Although two patients died because of multiple organ failure, a relatively satisfactory hemostatic response was obtained in at least 11/15 patients. However, patients with a baseline INR value above 2.5 never achieved an optimal response (INR value < 1.35). Conclusion:A single dose of 500 IU prothrombin complex concentrate is insufficient for normalization of INR value, especially in patients with prolonged INR values. Administration strategies for trauma, the ideal dose (e.g., higher than 500 IU/patient), target optimal INR values, as well as the confirmation of safety should be addressed in the future. Further clinical trials are warranted to confirm this preliminary report.

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