What question did this study set out to answer?

To evaluate clinical outcomes and efficacy of three-factor prothrombin complex concentrate (PCC) for international normalized ratio (INR) reversal in patients on oral anticoagulants presenting with acute bleeding.

June 4, 2014Annals of Pharmacotherapy

Outcomes Associated With Prothrombin Complex Concentrate for International Normalized Ratio Reversal in Patients on Oral Anticoagulants With Acute Bleeding

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Why the study?

Does 3-factor prothrombin complex concentrate improve INR reversal in patients on oral anticoagulants with acute bleeding?

Population

403 patients on oral anticoagulants with acute bleeding admitted to a level II trauma center who received…

Design

Cohort

Authors

RTRyan TiltonMission Health EMElizabeth Landrum MichaletsUniversity of North Carolina at Chapel Hill BDBethany DelkUniversity of Virginia Health System

Discussion

Member takes

Implication

May support 3-factor PCC for INR reversal in anticoagulant bleeding; leaves open randomized confirmation of survival benefit.

Key Points

To evaluate clinical outcomes and efficacy of three-factor prothrombin complex concentrate (PCC) for international normalized ratio (INR) reversal in patients on oral anticoagulants presenting with acute bleeding.
Retrospective cohort study conducted at a level II trauma center evaluating all patients who received PCC for INR reversal and acute bleeding management over a 5-year period from 2007 to 2012 (N=403).
Evaluated primary outcome of INR reversal to < 1.5, alongside secondary outcomes including bleeding cessation, mortality, protocol use, safety endpoints, and adjunct vitamin K or fresh frozen plasma (FFP) use.
Target INR (< 1.5) was achieved in 88.8% of patients, with success significantly associated with younger age (P = 0.02), institutional protocol utilization (P < 0.01), and concomitant vitamin K (P < 0.01), while FFP had no significant effect.
Bleeding cessation occurred in 82.6% (n=333) and mortality was 16.9% (n=68); achieving target INR significantly favored bleeding cessation (P < 0.01) and was associated with a 3.8-fold higher odds of survival (P < 0.01).
Thromboembolic events occurred in 3.7% of patients across the cohort.

Structured PICO

Does 3-factor prothrombin complex concentrate improve INR reversal in patients on oral anticoagulants with acute bleeding?

Population

403 patients on oral anticoagulants with acute bleeding admitted to a level II trauma center who received prothrombin complex concentrate for INR reversal

Intervention

3-factor prothrombin complex concentrate (PCC) with or without IV vitamin K or fresh frozen plasma

Outcome

Achievement of INR < 1.5surrogate

Three-factor PCC administration is effective for INR reversal and bleeding cessation in patients on oral anticoagulants with acute bleeding.

Cite This Study

Tilton et al. (2014) studied this question.

synapsesocial.com/papers/6a70d5e7660549caf2c57786 https://doi.org/10.1177/1060028014537897

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Outcomes Associated With Prothrombin Complex Concentrate for International Normalized Ratio Reversal in Patients on Oral Anticoagulants With Acute Bleeding

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Outcomes Associated With Prothrombin Complex Concentrate for International Normalized Ratio Reversal in Patients on Oral Anticoagulants With Acute Bleeding

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider