| Abstract: | BackgroundA bleeding patient undergoing therapy with new oral anticoagulants is every clinician’s nightmare as no specific reversal agent is available yet. This in vitro study investigated the effect of prothrombin complex concentrate (PCC), recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrate (aPCC) on supratherapeutic rivaroxaban concentrations using standard laboratory parameters (prothrombin time [PT], activated partial thromboplastin time [aPTT] and PT ratio) and thromboelastometry (clotting time [CT]).ResultsThe addition of the reversal agents had the following statistically significant effects (all p<0.01): +25 IU/kg PCC: CT −15 s, aPTT +5 s; +50 IU/kg PCC: aPTT +11 s; +90 μg rFVIIa: CT −141 s; +25 IU/kg aPCC: CT −142 s, aPTT −9 s, PT ratio +14%, PT −10.5 s; +50 IU/kg aPCC: CT −118 s, aPTT −7 s, PT ratio +17%, PT −12.2 s.DiscussionrFVIIa and aPCC, but not PCC, appear to shorten coagulation times significantly in standard laboratory and thromboelastometry assays. These results need confirmation through evaluation of these agents in the clinical setting. |
