Case series of four-factor prothrombin complex concentrate for warfarin reversal before heart transplantation

Describe the experience of using 4-factor prothrombin complex concentrate (PCC4) in patients with a ventricular assist device (VAD) scheduled for imminent heart transplant who are receiving warfarin.

We are reporting a clinical case series describing 4 patients with VADs treated with PCC4 for anticoagulation reversal before heart transplantation. Data collection was performed via retrospective medical chart review from March 27, 2014, to July 20, 2014.

Average time to anticoagulation reversal was 2.45 hours and average volume of PCC4 injection was 86 mL. No patient experienced a thromboembolic event or a decrease in hemoglobin indicative of a bleeding event. Average volume of packed red blood cells, platelets, and fresh frozen plasma (FFP) patients received was 2,325 mL. Patient 1 experienced a hypersensitivity reaction and patient 2 experienced thrombocytopenia postoperatively. The average acquisition cost was $3,824 and the average retail price was $7,143 per complete dose.

PCC4 contributed to efficient reduction of International Normalized Ratio (INR) before surgery. PCC4 requires less volume than FFP for similar INR reductions. PCC4 was a beneficial agent in our patients with VADs; however, a cost-benefit analysis is needed to evaluate the future utility of PCC4.