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Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 36-40

Three- versus four-factor prothrombin complex concentrate for the reversal of warfarin-induced bleeding

1 Department of Pharmacy, IU Health Methodist Hospital, Indianapolis, IN, USA
2 Department of Pharmacy, Via Christi Hospitals, Wichita, KS, USA
3 Department of Pharmacy, Grady Health System, Atlanta, GA, USA
4 Department of Pharmacy, Fletcher Allen Health Care, Burlington, VT, USA
5 Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
6 Department of Pharmacy, Bronson Methodist Hospital, Kalamazoo, MI, USA

Correspondence Address:
Dr. Tara Holt
Department of Pharmacy, IU Health Methodist Hospital, 1701 N. Senate Blvd, AG 401, Indianapolis, IN 46202
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCIIS.IJCIIS_40_17

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Objective: The objective of this study was to evaluate the effectiveness of 3-factor prothrombin complex concentrate (3F-PCC) compared to 4-factor PCC (4F-PCC) in warfarin-associated bleeding. Methods: This multicenter, retrospective, cohort study analyzed data from patients admitted between May 2011 and October 2014 who received PCC for warfarin-associated bleeding. The primary outcome was the rate of international normalized ratio (INR) normalization, defined as an INR ≤1.3, after administration of 3F-PCC compared to 4F-PCC. Other variables of interest included the incidence of additional reversal agents, new thromboembolic events, and mortality. Results: A total of 134 patients were included in the analysis. The average dose of PCC administered was 24.6 ± 9.3 units/kg versus 36.3 ± 12.8 units/kg in the 3F-PCC and 4F-PCC groups, respectively, P < 0.001. Baseline INR in the 3F-PCC and 4F-PCC groups was 3.61 ± 2.3 and 6.87 ± 2.3, respectively P < 0.001. 4F-PCC had a higher rate of INR normalization at first INR check post-PCC administration compared to 3F-PCC (84.2% vs. 51.9%, P = 0.0001). Thromboembolic events, intensive care unit and hospital length of stay, and mortality were similar among both groups. Conclusion: The use of 4F-PCC leads to a more significant reduction in INR compared to 3F-PCC though no difference in mortality or length of stay was observed. Thromboembolism rates were similar among both groups.

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