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Prothrombin complex concentrate in the management of major bleeding induced by oral anticoagulant therapy
Mohammed AlSheef1, Ghaydaa Kullab1, Modhi Alajmi1
1From the Medical Specialties Department (AlSheef), from the Internal Medicine Department (Kullab), from the Research Center (Abu-Shaheen), King Fahad Medical City; from the Internal Medicine Department (Kullab, Zaidi), Dr. Sulaiman Al Habib Medical Group, Riyadh; from the College of Medicine (Al Baqmi), King Saud Bin Abdulaziz University for Health Sciences; from the College of Health and Rehabilitation Sciences (Alajlan), Princess Noura Bint Mohammed University, Riyadh; from the College of Medicine (Alajmi), Imam Abdulrahman Bin Faisal University, Dammam; and from the College of Medicine (Aldhaheri), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
Objectives:
To share clinical data on the efficacy of 4F-PCC in the treatment of major bleeding caused by warfarin, dabigatran, and rivaroxaban.
Methods:
This is a retrospective study of patients admitted to King Fahad Medical City, Riyadh, Saudi Arabia with major bleeding caused by oral anticoagulants and treated with 4-factor prothrombin complex concentrate (4F-PCC). The International Society of Thrombosis and Hemostasis Scientific and Standardization Subcommittee criteria were used to evaluate the effectiveness of PCCs.
Results:
A total of 22 patients were included in the study. Ten of the events were caused by gastrointestinal bleeding (46%). In the majority of patients, anticoagulation was prescribed for stroke prevention, atrial fibrillation, and venous thromboembolism. The median international normalized ratio was significantly lower before and after PCC administration (p<0.001). In patients treated with 4-factor PCC, the rate of thromboembolic events was 0%. The hemostatic effectiveness of PCC was effective in 19 patients. During treatment, no clinically significant bleeding complications occurred.
Conclusion:
Prothrombin complex concentrate can effectively reverse the effects of warfarin and rivaroxaban in patients with major bleeding, but only partially reverses the effect of dabigatran.
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