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. 2023 Jan;15(1):51-57.
doi: 10.14740/jocmr4856. Epub 2023 Jan 24.

Reduced Time to Procedure for Gastrointestinal Bleeding After Warfarin Reversal With Four-Factor Complex Concentrate as Compared to Plasma

Hannah Spector  1 , Hannah L McRae  1 , Tanzy Love  2 , Kalynn Northam  3 , Khaled Refaai  1 , Marian A Rollins-Raval  4 , Majed A Refaai  1
Affiliations

Reduced Time to Procedure for Gastrointestinal Bleeding After Warfarin Reversal With Four-Factor Complex Concentrate as Compared to Plasma

Hannah Spector et al. J Clin Med Res. 2023 Jan.

Abstract

Background: Bleeding is a serious adverse effect of vitamin K antagonists (VKAs). Anticoagulation reversal is required in some acute cases. This is usually accomplished by plasma transfusion or four-factor prothrombin complex concentrate (4F-PCC). The aim of this study was to gain insight into the clinical course of patients with gastrointestinal (GI) bleeding who require VKA reversal.

Methods: Medical records were collected from two centers from patients who presented to the emergency department (ED) for GI bleeding and received 4F-PCC or plasma for VKA reversal between January 2015 and December 2020. ED, hospital, intensive care unit (ICU) length of stay (LOS) as well as time from admission to GI procedure were determined.

Results: 4F-PCC patients (n = 49) as compared to plasma (n = 63) patients were found to have a greater number of comorbidities (average of 4.2 vs. 2.7 comorbidities/patient) and more ICU admissions (47% vs. 21%). Time to GI procedure was significantly decreased in the 4F-PCC group (median (interquartile range (IQR)) 19.47 (9.23 - 30.25) vs. 27.88 (21.38 - 45.00) h; P = 0.01). When adjusting for comorbidities, differences in time to GI procedures were also significant in favor of 4F-PCC regardless of any comorbidities (P = 0.014), in atrial fibrillation (P = 0.045) and in hypertension (P = 0.02). The 4F-PCC patients had shorter LOS in the ED and ICU.

Conclusions: Our study demonstrated that compared to plasma, 4F-PCC was utilized in more acutely ill patients with higher rates of comorbidities and ICU admission. Nevertheless, the patients who received 4F-PCC had faster access to GI procedure and shorter ED and ICU LOS.

Keywords: Anticoagulation reversal; Gastrointestinal hemorrhage; Plasma; Prothrombin complex concentrate; Warfarin.

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Conflict of interest statement

Majed A. Refaai is on the advisory committee and is a consultant for Cerus, Diagnostica Stago, and CSL Behring. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Intensive care unit lengths of stay (in days) in the plasma and 4F-PCC groups. In each boxplot, the bold line is the median, the other lines are the quartiles of the data with outlier values displayed individually as points. 4F-PCC: four-factor prothrombin complex concentrate.
Figure 2
Figure 2
Emergency department lengths of stay (in h) in the plasma and 4F-PCC groups. In each boxplot, the bold line is the median, the other lines are the quartiles of the data with outlier values displayed individually as points. 4F-PCC: four-factor prothrombin complex concentrate.
Figure 3
Figure 3
Time from admission to GI procedure (in h) in the plasma and 4F-PCC groups. In each boxplot, the bold line is the median, the other lines are the quartiles of the data with outlier values displayed individually as points. GI: gastrointestinal; 4F-PCC: four-factor prothrombin complex concentrate.
See this image and copyright information in PMC

References

    1. Hirsh J, Dalen J, Anderson DR, Poller L, Bussey H, Ansell J, Deykin D. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 2001;119(1 Suppl):8S–21S. doi: 10.1378/chest.119.1_suppl.8S. - DOI - PubMed
    1. Kuruvilla M, Gurk-Turner C. A review of warfarin dosing and monitoring. Proc (Bayl Univ Med Cent) 2001;14(3):305–306. doi: 10.1080/08998280.2001.11927781. - DOI - PMC - PubMed
    1. Chen WC, Chen YH, Hsu PI, Tsay FW, Chan HH, Cheng JS, Lai KH. Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome. Biomed Res Int. 2014;2014:463767. doi: 10.1155/2014/463767. - DOI - PMC - PubMed
    1. Rubin TA, Murdoch M, Nelson DB. Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes. Gastrointest Endosc. 2003;58(3):369–373. doi: 10.1016/S0016-5107(03)00010-5. - DOI - PubMed
    1. Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Frequency of major complications of aspirin, warfarin, and intravenous heparin for secondary stroke prevention. A population-based study. Ann Intern Med. 1999;130(1):14–22. doi: 10.7326/0003-4819-130-1-199901050-00004. - DOI - PubMed

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