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Prothrombin complex concentrate for direct factor Xa inhibitor-associated bleeding or before urgent surgery
Joseph R Shaw1, Abdulrahman Abdulaziz Almujalli1, Yan Xu1
1Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Thrombosis Research
|October 3, 2024
Summary
Four-factor prothrombin complex concentrate (4F-PCC) effectively managed Factor Xa inhibitor (FXaI)-associated bleeding in two-thirds of patients. Thromboembolic events were infrequent, indicating 4F-PCC is a promising FXaI bleed management strategy.
Area of Science:
- Pharmacology
- Hematology
- Critical Care Medicine
Background:
- Factor Xa inhibitor (FXaI) associated bleeding events are common and lead to significant morbidity.
- There is a need for effective and affordable management strategies for FXaI-associated bleeding.
Purpose of the Study:
- To evaluate the hemostatic efficacy and safety of 4-factor prothrombin complex concentrate (4F-PCC) in patients with FXaI-associated bleeding or requiring urgent surgery.
- To assess the incidence of thromboembolic events following 4F-PCC administration.
Main Methods:
- Single-center retrospective cohort study of patients treated with 4F-PCC for FXaI-associated bleeding or urgent surgery.
- Data collected on hemostatic efficacy and 30-day thromboembolic risk.
- Patients received 25-50 IU/kg of 4F-PCC.
Main Results:
- Effective hemostasis was achieved in 66.7% of patients with FXaI-associated bleeding.
- Surgical hemostasis was rated normal in 95.5% of patients undergoing urgent surgery.
- The 30-day risk of thromboembolism was 7.6%, with an overall mortality of 22.9%.
Conclusions:
- 4F-PCC demonstrated hemostatic efficacy in two-thirds of patients with FXaI-associated bleeding.
- Thromboembolic events were uncommon, suggesting 4F-PCC is a viable treatment option.
- 4F-PCC is a promising strategy for managing FXaI-associated bleeding.
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