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Updated: Dec 21, 2025
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Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
Published on: September 9, 2012
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Efficacy of 4-Factor Prothrombin Complex Concentrates in Factor Xa Inhibitor-Associated Intracranial Bleeding
Matthew J Korobey1, Farid Sadaka2, Muhammad Javed2
1Department of Critical Care Medicine, Mercy Hospital St. Louis, 615 S. New Ballas Road, St. Louis, MO, 63303, USA. Matthew.korobey@mercy.net.
Neurocritical Care
|May 21, 2020
Summary
4-Factor Prothrombin Complex Concentrates (4FPCC) effectively reversed Factor Xa inhibitor-associated intracranial bleeding (ICB) in 88% of patients. This study suggests 4FPCC is a safe and viable option for managing ICB complications.
Area of Science:
- Neurology
- Hematology
- Pharmacology
Background:
- Intracranial bleeding (ICB) is a serious risk of anticoagulation therapy.
- Factor Xa inhibitors (FXaI) are widely used, necessitating effective reversal agents.
- Andexanet alfa is approved for FXaI reversal, but 4-Factor Prothrombin Complex Concentrates (4FPCC) are often used.
Purpose of the Study:
- To evaluate the hemostatic efficacy of 4FPCC in patients with FXaI-associated ICB.
- To compare the outcomes of 4FPCC to existing reversal strategies.
Main Methods:
- Retrospective cohort study of 59 patients receiving 4FPCC for FXaI-associated ICB.
- Hemostatic efficacy assessed via CT scan criteria (excellent <20% expansion, good 20-35% expansion, poor >35% expansion).
- Interrater reliability assessed by two neurointensivist attendings; mortality and thrombotic events tracked.
Main Results:
- 88% of patients achieved excellent or good hemostatic outcomes.
- High survival rate of 89.8% observed.
- Thrombotic events occurred in 11.9% of patients.
Conclusions:
- 4FPCC demonstrates effectiveness and safety for FXaI-associated ICB.
- Outcomes appear comparable to andexanet alfa.
- Prospective studies comparing 4FPCC and andexanet alfa, including cost-effectiveness, are recommended.
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