High versus low fixed-dose four factor-prothrombin complex concentrate for warfarin reversal in patients with intracranial hemorrhage |
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| Institution: | 1. Carter BloodCare, Bedford, TX, United States;2. Department of Radiology (Neuroradiology), UT Southwestern Medical Center, Dallas, TX, United States;3. Department of Pathology, UT Southwestern Medical Center, Dallas, TX, United States;4. Department of Internal Medicine (Hematology/Oncology), UT Southwestern Medical Center, Dallas, TX, United States;1. Department of Transfusion Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai 410210, India;1. Serviço de Hemoterapia da UNIFESP, São Paulo, Brazil;2. Fundação Pró-Sangue São Paulo Hemocenter, São Paulo, Brazil;3. Hematology Unit, University of São Paulo, School of Medicine, Brazil;4. Department of Hematology, Churchill Hospital, NHS BT, Oxford University, Oxford, United Kingdom;5. Institute of Tropical Medicine, University of São Paulo, School of Medicine, São Paulo, Brazil;1. Department of Transfusion Medicine, All India Institute of Medical Sciences, Rishikesh, India;2. Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India;3. Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, India |
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| Abstract: | BackgroundFour-factor prothrombin complex concentrate 4F-PCC is the standard of care for warfarin reversal in patients with major bleed or requiring urgent surgery. Although the 4F-PCC dose is weight and international normalized ratio (INR) based, for practical purposes, a fixed-dose approach has been explored, especially for rapid reversal. We report our experience using two different fixed-dose 4F-PCC for warfarin reversal in patients presenting with intracranial hemorrhage (ICH).Study design and methodsWe completed a retrospective chart review comparing high (4000 units) versus low (2000 units) dose 4F-PCC by evaluating patient characteristics, laboratory data, and pre-and post-4F-PCC brain imaging.ResultsThere was no significant difference between patient characteristics or INR correction (≤1.5) between the two groups. Eighty percent (12/15) of patients who received the low dose 4F-PCC had either improved or stable brain imaging as compared to 88% (14/16) of patients who received the high dose PCC. When the eight patients (4 from each arm of the study) who required neurosurgery were excluded, only two patients in each arm had worse imaging after 4F-PCC.ConclusionThere was no significant difference between the INR correction and the brain imaging changes in patients with an ICH who received either the high or the low fixed-dose 4F-PCC for warfarin reversal. |
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| Keywords: | PCC Prothrombin complex concentrate Kcentra Intracranial hemorrhage Warfarin Coumadin |
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