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Updated: Nov 8, 2025
A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
Published on: June 4, 2021
Low-dose versus standard-dose four-factor prothrombin complex concentrate for factor-Xa inhibitor reversal in
Ava E Cascone1, Mitchell J Daley2, Neil Pan2
1Department of Pharmacy, Boston Medical Center, Boston, Massachusetts, USA.
Study Objectives:
Current neurocritical care guidelines recommend 50 IU/kg four-factor prothrombin complex concentrate (4PCC) for factor Xa inhibitor (FXaI) reversal in intracranial hemorrhage (ICH) based on few clinical studies conducted among non-ICH subjects. Two recent studies suggest that low-dose (25 IU/kg) 4PCC may be similar to 50 IU/kg in reversal of FXaI in ICH, and both 25 and 50 IU/kg doses are used in clinical practice for this indication. To our knowledge, no studies have directly compared 25 IU/kg versus 50 IU/kg 4PCC for FXaI reversal in ICH. The purpose of this study is to determine whether there is a difference in hemostatic efficacy between 25 IU/kg versus 50 IU/kg 4PCC for FXaI reversal in ICH.
Design:
This multicenter, retrospective cohort study was performed in five hospitals in central Texas from November 2013 to December 2019.
Data Source:
Patients were identified with a medication use report of 4PCC and were classified in the low- or standard-dose group based on whether the 25 IU/kg or 50 IU/kg dose was received, respectively.
Patients:
A total of 93 patients were included (25 IU/kg, n = 62; 50 IU/kg, n = 31).
Measurements And Main Results:
There was no difference in hemostatic efficacy between groups (82.3% low dose vs. 83.9% standard dose, p = 0.846). No differences were identified in-hospital mortality, length of stay, thrombotic events, or the need for surgery or additional blood products between groups.
Conclusion:
For the reversal of FXaI in ICH, a 25 IU/kg dose may be an effective alternative to 50 IU/kg 4PCC dosing.
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