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A Tertiary Academic Medical Center Blood Bank's Experience With Four-Factor Prothrombin Complex Concentrate.

Aaron D Shmookler1, Tracie L Nichols1, Peter L Perrotta1

  • 1Transfusion Services, WVU Medicine, Morgantown, WV, USA.

American Journal of Clinical Pathology
|February 20, 2021
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Summary

Prospective auditing (PA) of four-factor prothrombin complex concentrate (4F-PCC) orders ensures appropriate dosing without negatively impacting patient outcomes. This transfusion medicine service optimizes 4F-PCC use in patients with anticoagulant-associated hemorrhage.

Keywords:
Blood banksCP coagulationCP transfusion medicineEmergency serviceFactor IX complexFactor Xa inhibitorsHospitalIntracranial hemorrhagesPharmacyQualityWarfarin

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Area of Science:

  • Transfusion Medicine
  • Hematology
  • Pharmacology

Background:

  • Four-factor prothrombin complex concentrate (4F-PCC) is crucial for reversing anticoagulation in patients with hemorrhage.
  • Transfusion medicine consultative services play a role in optimizing the use of blood products and derivatives.
  • Prospective auditing (PA) is a strategy to review and guide medication orders before administration.

Purpose of the Study:

  • To evaluate the impact of transfusion medicine consultative services performing prospective auditing (PA) on four-factor prothrombin complex concentrate (4F-PCC) orders.
  • To assess the effect of PA on 4F-PCC dosing, turnaround time (TAT), and patient outcomes.
  • To determine if PA influences concentrate issuance, laboratory values, or product wastage.

Main Methods:

  • A retrospective analysis of 4 years of 4F-PCC orders at an academic medical center.
  • Data collected from the laboratory information system and electronic health records of 427 patients receiving 4F-PCC for warfarin-, apixaban-, or rivaroxaban-associated hemorrhage.
  • Comparison of TAT, concentrate amounts issued, international normalized ratio (INR) normalization, order cancellation, and wastage rates between groups with and without PA-recommended dose adjustments.

Main Results:

  • PA and dose adjustments reduced 4F-PCC issuance by 27 IU per dose (P=.01).
  • Turnaround time (TAT) was longer when PA-recommended dose adjustments were needed (85 vs 66 minutes, P=.03), but shortest from the emergency department (ED) (64 minutes).
  • Median INR < 1.3 was achieved for all anticoagulants post-transfusion after dose adjustments; PA did not affect cancellation or wastage rates.

Conclusions:

  • Prospective auditing (PA) by transfusion medicine services ensures appropriate dosing of 4F-PCC.
  • PA does not negatively affect patient outcomes, including TAT or wastage.
  • This consultative service optimizes 4F-PCC utilization in patients with anticoagulant-associated bleeding.