The benefit of prothrombin complex concentrate in decreasing neurological deterioration in patients with warfarin-associated intracerebral haemorrhage

Fong, Wing Chi; Lo, Wai-Ting; Ng, Y W; Cheung, Y F; Wong, Gordon C K; Ho, Hiu Fai; Chan, James C.; Li, Patrick C K

doi:10.12809/hkmj144246

Cited by 6 publications

(12 citation statements)

References 15 publications

(23 reference statements)

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“…14 Potential reasons for this include differences in study design, early referral to stroke units, the widespread use and avail-PCC for VKA-Associated ICH studies that reported hematoma expansion outcomes generally favored the use of PCC over plasma, 31,33,39 or showed no signficant difference between groups. 32 Overall, there is currently a lack of comparative evidence from RCTs in this population, with only 1 recent RCT conducted in patients with VKA-associated ICH. 39 Although other controlled comparisons of PCC and plasma have been conducted for urgent VKA reversal in cases of major bleeding 44 or prior to urgent surgical procedures, 45 these studies included few patients with ICH.…”

mentioning

confidence: 99%

Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage　― Global Evidence and the Japanese Perspective ―

Yasaka

Brainsky

Toyoda

2017

Circ J

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Patients receiving vitamin K antagonists (VKAs) are at increased risk of bleeding. Intracranial hemorrhage (ICH) is a major cause of morbidity and mortality in this population, and is a particular concern among Japanese clinicians, given reports of an elevated risk of this bleeding type in patients of Asian ethnicity. Patients with VKA-associated ICH require rapid international normalized ratio (INR) reversal, and treatment guidelines suggest the use of prothrombin complex concentrates (PCCs) or plasma for this purpose. Although European and US guidelines recommend PCCs for the treatment of VKA-associated major bleeding, they do not make a specific recommendation in the setting of ICH, owing to the lack of comparative evidence. In contrast, Japanese guidelines recommend the use of PCCs rather than plasma for VKA reversal in patients with ICH; however, these agents are not currently licensed in Japan for this indication. Here we review the available evidence on the use of PCCs for the treatment of VKA-associated ICH, both globally and specifically in Japanese settings. Overall, the evidence reviewed here supports the use of PCC for rapid VKA reversal in these patients.

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mentioning

confidence: 99%

Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage　― Global Evidence and the Japanese Perspective ―

Yasaka

Brainsky

Toyoda

2017

Circ J

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“…In 2014, Fong et al [9] in a historical cohort study compared patients with intracranial haemorrhage related to warfarin who received either PCC or FFP. After 24 hours, the median INR value changed from 2.8 to 1.2 upon PCC administration.…”

Section: Discussionmentioning

confidence: 99%

“…There were no thrombotic problems [9]. How FFP is not a pure composite, maybe other substances could disturb coagulation properties, becoming it less effective.…”

Section: Discussionmentioning

confidence: 99%

“…The comparison between the in vivo use of prothrombin complex concentrate (PCC) and frozen fresh plasma (FFP) in cardiology patients remains uncertain. Recent studies have shown superiority of prothrombin complex concentrate (PCC) over frozen fresh plasma (FFP) administration in situations, such as in surgical patients or patients with intracranial bleeding, reducing transfusion requirements and even mortality [1]- [9]. Furthermore, PCC reduces the risk of transmission of infective agents.…”

Section: Introductionmentioning

confidence: 99%

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Superiority of Prothrombin Complex Concentrate versus Frozen Fresh Plasma in Cardiology Patients with Warfarin Intoxication–Observational Study

Soeiro¹,

César²,

Biselli³

et al. 2017

OJEM

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Objective: The objective of this study was to analyse the reversibility of the anticoagulant effect of warfarin by comparing prothrombin complex concentrate (PCC) versus frozen fresh plasma (FFP) in cardiology patients with serious warfarin intoxication. Methods: This was an observational and retrospective study comprising 67 patients (18 in group I [PCC] and 49 in group II [FFP]). The primary endpoint was the reversal of anticoagulant effect of warfarin after 2 and 24 hours of PCC or FFP administration. Comparisons between the groups were made using T-test and Q-square. Multivariate analyses were conducted using logistic regression, and the results were considered significant when p < 0.05. Complementary analysis was performed using the ROC curve, calculating the area under the curve (AUC), and calculating the cut-off score for the relation between PCC (UI/kg) or FFP (ml/kg) and INR reversibility. Results: The medium dose used was 27.6 UI/kg of PCC and 14.5 ml/kg of FFP. Significant differences were observed between groups I and II in the INR reversibility measurements after 2 hours (33.3% vs. 6.1%, p = 0.001) and 24 hours (38.9% vs. 12.2%, p = 0.009) as well as in the occurrence of pulmonary edema (5.6% vs. 42.9%, OR = 11.10, p = 0.04). The AUC for PCC was 0.891 (CI 95% [0.72 -1.0]), and for FFP, it was 0.291 (CI 95% [0.09 -0.49]). Conclusions: PCC is better than FFP treatment in reversing the warfarin intoxication after 2 and 24 hours of administration. Furthermore, PCC showed lower pulmonary edema in cardiology patients.

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“…В настоящее время многие клиницисты рассматривают КПК как серьезную альтернативу применению СЗП при коагулопатиях, обусловленных печеночной недостаточностью, и кровотечениях различной этиологии [13][14][15][16].…”

Section: таблица 1 препараты факторов свертывания кровиunclassified

Роль И Место Экзогенных Факторов Свертывания Крови При Акушерских Кровотечениях

Сединкин¹,

Кlygunenko²

2021

ЕМ

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Роль и место экзогенных факторов свертывания крови при акушерских кровотечениях Резюме. Работа посвящена обсуждению актуального места и перспектив клинического применения в интенсивной терапии массивной акушерской кровопотери гемостатических препаратов-концентратов факторов свертывания крови. Острая массивная акушерская кровопотеря остается одной из основных причин развития синдрома полиорганной недостаточности в перипартальном периоде, что приводит к значительному повышению 42-дневной летальности и длительности госпитализации в отделении интенсивной терапии. Приведен опыт применения в акушерской практике концентрата протромбинового комплекса и рекомбинантного активированного фактора свертывания VII. Применение экзогенных факторов свертывания для профилактики и лечения коагулопатии при массивной акушерской кровопотере позволяет быстро восстановить дефицит прокоагулянтных факторов, поддержать баланс между свертывающей и противосвертывающей системами и в конечном результате-снизить частоту и количество проявлений синдрома полиорганной недостаточности, увеличить выживаемость пациенток, минимизировать риск трансфузионных осложнений, сохранить репродуктивную функцию.

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The benefit of prothrombin complex concentrate in decreasing neurological deterioration in patients with warfarin-associated intracerebral haemorrhage

Abstract: Objective: To compare the outcomes of patients with warfarin-associated intracerebral haemorrhage given different treatments to reverse the effect of anticoagulation.

Cited by 6 publications

References 15 publications

Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage　― Global Evidence and the Japanese Perspective ―

Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage　― Global Evidence and the Japanese Perspective ―

Superiority of Prothrombin Complex Concentrate versus Frozen Fresh Plasma in Cardiology Patients with Warfarin Intoxication–Observational Study

Роль И Место Экзогенных Факторов Свертывания Крови При Акушерских Кровотечениях

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The benefit of prothrombin complex concentrate in decreasing neurological deterioration in patients with warfarin-associated intracerebral haemorrhage

Abstract: Objective: To compare the outcomes of patients with warfarin-associated intracerebral haemorrhage given different treatments to reverse the effect of anticoagulation.

Cited by 6 publications

References 15 publications

Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage ― Global Evidence and the Japanese Perspective ―

Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage ― Global Evidence and the Japanese Perspective ―

Superiority of Prothrombin Complex Concentrate versus Frozen Fresh Plasma in Cardiology Patients with Warfarin Intoxication–Observational Study

Роль И Место Экзогенных Факторов Свертывания Крови При Акушерских Кровотечениях

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Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage　― Global Evidence and the Japanese Perspective ―

Prothrombin Complex Concentrate for Vitamin K Antagonist-Associated Intracranial Hemorrhage　― Global Evidence and the Japanese Perspective ―