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Comparative Study
. 2025 Feb;58(2):276-283.
doi: 10.1007/s11239-024-03052-4. Epub 2024 Oct 28.

3-Factor prothrombin complex concentrate versus 4-factor prothrombin complex concentrate for the reversal of oral factor Xa inhibitors

William Blake Hays  1 , Kelsey Billups  2 , Jessica Nicholson  3 , Abby M Bailey  4 , Haili Gregory  5 , Erin R Weeda  6 , Kyle A Weant  7
Affiliations
Comparative Study

3-Factor prothrombin complex concentrate versus 4-factor prothrombin complex concentrate for the reversal of oral factor Xa inhibitors

William Blake Hays et al. J Thromb Thrombolysis. 2025 Feb.

Abstract

Multiple agents exist for the reversal of oral Factor Xa inhibitor (FXa) associated bleeding, including Coagulation FXa Recombinant, Inactivated zhzo (andexanet alfa) and 4-factor prothrombin complex concentrate (4F-PCC). While classified as a 3F-PCC product, Profilnine contains up to 35 IU of Factor VII (per 100 IU of Factor IX) in addition to therapeutic levels of Factors II, IX, and X, and has demonstrated a similar impact on prothrombin time and blood product usage in non-warfarin related bleeding. This was a retrospective, multicenter study at four medical centers of adult patients who presented with major bleeding associated with oral FXa inhibitors and received either 4F-PCC (n = 64) or 3F-PCC (n = 61). The primary outcome was hemostatic effectiveness. Secondary outcomes included the incidence of thromboembolism, in-hospital mortality, and length of stay. The most common indication for reversal was intracranial bleeding. For the primary outcome, 84% of all patients were rated as effective with no difference noted between the groups (p = 0.81). No significant difference between groups was found in the multivariable analysis adjusting for baseline differences between groups including race, total body weight, type of bleeding, and the use of antiplatelet therapy. There was no difference in the length of stay, in-hospital mortality, or the incidence of thromboembolism between the groups. Overall, no significant differences were found in the effectiveness or safety of 4F-PCC and 3F-PCC use in the management of oral FXa inhibitor-associated bleeding. Further investigations are warranted to explore the use of 3F-PCC for this indication and its safety and effectiveness.

Keywords: Factor IX; Factor VII; Factor Xa inhibitors; Hemorrhage; Hemostatics; Platelet aggregation inhibitors; Prothrombin complex concentrations; Thromboembolism.

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Conflict of interest statement

Declarations. Conflict of interest: These authors have nothing to disclose.

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Schematic of patient selection process
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