Protocolized use of Factor Eight Inhibitor Bypassing Activity (FEIBA) for the reversal of warfarin induced coagulopathy

Htet, Natalie N.; Barounis, David; Knight, C. A.; Umunna, Ben-Paul; Hormese, Mary; Lovell, Elise

doi:10.1016/j.ajem.2019.05.047

Cited by 8 publications

(8 citation statements)

References 34 publications

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“…Secondary end points observed in this analysis are consistent with previous trials and provide additional support for the safety of aPCC. Incidence of thrombotic events in this study was lower than in the previous analysis by Htet et al 22 (1% vs 5%) but similar to the rates observed by Smetana et al 5 (1% vs 2%). Neither of the aforementioned analyses reported time to initiation of VTE prophylaxis, and it is likely that institutional protocols regarding type and timing of VTE prophylaxis are widely variable.…”

Section: Discussionsupporting

confidence: 86%

“…The median time to repeat INR was 45 minutes (IQR = 38-55), with 16.3% of patients requiring a second dose of 500 units to achieve the target INR. 22 This supports the efficacy of a fixed dosing protocol, although patient weight was not reported in this study, so it is unclear as to whether the additional doses required could have been attributed to obesity. Chu et al 25 evaluated 51 patients who received PCC for warfarin-associated ICH and found that obesity (BMI > 30 kg/m 2 ) was significantly associated with INR reversal failure (41% vs 14%, P = 0.03).…”

Section: Discussionsupporting

confidence: 70%

“…3,7,15,20 Recent studies have utilized similar aPCC dosing strategies and observed similar INR reversal rates, although few studies have specifically evaluated the impact of obesity. Htet et al 22 recently conducted a prospective observational study of 43 patients utilizing the same fixed-dose strategy utilized by our institution and found that 93% of patients achieved a target INR of <1.5 after aPCC administration. The median time to repeat INR was 45 minutes (IQR = 38-55), with 16.3% of patients requiring a second dose of 500 units to achieve the target INR.…”

Section: Discussionmentioning

confidence: 99%

“…Both fixed and weight-based aPCC dosing strategies have been evaluated. 3,6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] A fixed dosing strategy offers several advantages to weight-based dosing, including decreased time to administration, smaller infusion volume, and reduction in cost and waste. However, there is a paucity of evidence related to successful INR reversal in patients with BMI ≥30 kg/m 2 using fixed dosing protocols with aPCC.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Obesity on Warfarin Reversal With Fixed-Dose Factor VIII Inhibitor Bypassing Activity (aPCC)

et al. 2020

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Background: Data are limited addressing anticoagulant reversal in obese patients using activated prothrombin complex concentrate (aPCC). Objective: Assess the impact of obesity on INR reversal with fixed aPCC dosing. Methods: Institutional review board–approved, retrospective cohort conducted in a large academic medical center. Patients 18 years or older who received fixed-dose aPCC for warfarin-associated hemorrhage were included. Patients who received aPCC for any other indications or who had no follow-up INR after aPCC administration were excluded. Patients with an INR of 5 or greater received 1000 units aPCC, whereas those with INR less than 5 received 500 units aPCC, per institutional protocol. Patients were stratified into obese and nonobese based on body mass index. Primary end point was INR reversal, defined as repeat INR of 1.4 or less within 4 hours following aPCC treatment, without a repeated dose. Secondary end points included percentage change in INR, proportion of patients requiring an additional dose of aPCC, bleeding complications, thrombotic complications, hospital length of stay, and in-hospital mortality. Results: 259 patients were included, of whom 83 were obese (32%). A significantly higher proportion of nonobese patients achieved an INR of 1.4 or less within 4 hours of treatment (169 [96.02%] vs 69 [83.13%]; P = 0.0004). There were no differences in any secondary end points. Conclusion and Relevance: When fixed-dose aPCC is used for warfarin reversal, obesity is associated with a significantly lower rate of INR reversal, without increased bleeding. This study adds to the limited amount of literature on aPCC dosing in obesity.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Obesity on Warfarin Reversal With Fixed-Dose Factor VIII Inhibitor Bypassing Activity (aPCC)

et al. 2020

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“…A low fixed-dose approach offers several advantages over traditional dosing, including decreased time to administration and costs. Although not FDA approved for managing warfarin-associated coagulopathies, Factor VIII inhibitor bypass activity (FEIBA) is used for this indication [ 18 , 19 , 20 , 21 , 22 ]. FEIBA is approved for managing hemophiliac-related hemorrhages and, as opposed to Kcentra, contains activated factor VII.…”

Section: Introductionmentioning

confidence: 99%

Fixed-Dose Factor Eight Inhibitor Bypassing Activity (FEIBA) in the Management of Warfarin-Associated Coagulopathies

et al. 2022

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This retrospective review evaluated our institutions’ practice of administering low fixed-dose FEIBA (high (1000 units) or low dose (500 units) for an INR ≥ 5 or < 5, respectively) for the management of warfarin-associated coagulopathies. The primary outcome was the percentage of patients who had a post-FEIBA INR ≤ 1.5. In the total population, 55.6% (10/18) of patients achieved a post-FEIBA INR ≤ 1.5. In the subgroup analysis, significantly more patients in the low dose FEIBA group achieved a post-FEIBA INR ≤ 1.5 compared to the high dose FEIBA group (71.4% vs. 45.5%, respectively, p < 0.001). In the post hoc analysis, there was a significant difference in the number of patients who achieved a post-FEIBA INR ≤ 1.5 when comparing those who received high dose FEIBA with a baseline INR 5–9.9 to those who received high dose FEIBA with a baseline INR ≥ 10 (60% vs. 33.3%, respectively, p < 0.001). The existing literature and our findings suggest that patients who present with lower baseline INR values and receive additional reversal agents are more likely to meet post-reversal INR goals. Current low fixed-dose protocols may be oversimplified and may need to be revised to provide larger fixed-doses.

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Mediastinal Bleeding

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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Protocolized use of Factor Eight Inhibitor Bypassing Activity (FEIBA) for the reversal of warfarin induced coagulopathy

Cited by 8 publications

References 34 publications

Impact of Obesity on Warfarin Reversal With Fixed-Dose Factor VIII Inhibitor Bypassing Activity (aPCC)

Impact of Obesity on Warfarin Reversal With Fixed-Dose Factor VIII Inhibitor Bypassing Activity (aPCC)

Fixed-Dose Factor Eight Inhibitor Bypassing Activity (FEIBA) in the Management of Warfarin-Associated Coagulopathies

Mediastinal Bleeding

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