Key result
In 861 patients with OAC-associated bleeding, 4F-PCC was predominantly used for apixaban (82%) and rivaroxaban (77%) reversal, while plasma was mostly used for warfarin reversal (53%).
Why the study?
Real-world utilization of 4-factor prothrombin complex concentrate (4F-PCC) and plasma for managing oral anticoagulant-associated bleeding in US trauma hospitals was described to evaluate practice patterns across medical specialties.
Observational (n=861)
Yes
Despite guidelines not recommending it, plasma is still frequently used for OAC reversal, particularly in patients on warfarin, highlighting a gap in guideline-directed bleeding management.
Maps real-world 4F-PCC and plasma use in OAC reversal; leaves open optimal strategies for prospective trials.
Real-world utilization of 4-factor prothrombin complex concentrate (4F-PCC) and plasma for the management of oral anticoagulant (OAC)-associated bleeding in US trauma hospitals was described.This is amulticenter, retrospective chart review evaluating the use of 4F-PCC and plasma in OAC reversal across medical specialties. Physicians completed a survey and extracted data from 3 to 5 patient charts. Variables of interest included medical specialty, urgency, and bleed type. Two hundred and thirty-five physicians completed the survey, and 861 patient charts were included in the study. 4F-PCC was commonly used in life-threatening or emergent indications, whereas plasma was used in emergent and urgent indications. Plasma was used mostly for patients on warfarin (53% vs 47% 4F-PCC) and 4F-PCC for those on apixaban (82% vs 18% plasma) and rivaroxaban (77% vs 23% plasma). This retrospective analysis showed that 4F-PCC was predominantly used for OAC reversal despite available specific reversal agents for some of the OAC. Although it is not recommended by any reversal guidelines, plasma is still used for OAC reversal. Plasma should be avoided in the management of OAC-associated bleeding.
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Refaai et al. (2023) conducted an observational in Oral anticoagulant-associated bleeding (n=861). 4-factor prothrombin complex concentrate (4F-PCC) vs. Plasma was evaluated on Utilization patterns by oral anticoagulant type. In 861 patients with OAC-associated bleeding, 4F-PCC was predominantly used for apixaban (82%) and rivaroxaban (77%) reversal, while plasma was mostly used for warfarin reversal (53%).
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