Nuckles K B, Pratt J H, Cameron C M, Ingemi A I
Virginia Commonwealth University School of Pharmacy, Sentara Norfolk General, Norfolk, Virginia.
Pharmacy Services, Sentara Norfolk General, Norfolk, Virginia.
Transplant Proc. 2015 Apr;47(3):841-3. doi: 10.1016/j.transproceed.2015.02.008.
Describe the experience of using 4-factor prothrombin complex concentrate (PCC4) in patients with a ventricular assist device (VAD) scheduled for imminent heart transplant who are receiving warfarin.
We are reporting a clinical case series describing 4 patients with VADs treated with PCC4 for anticoagulation reversal before heart transplantation. Data collection was performed via retrospective medical chart review from March 27, 2014, to July 20, 2014.
Average time to anticoagulation reversal was 2.45 hours and average volume of PCC4 injection was 86 mL. No patient experienced a thromboembolic event or a decrease in hemoglobin indicative of a bleeding event. Average volume of packed red blood cells, platelets, and fresh frozen plasma (FFP) patients received was 2,325 mL. Patient 1 experienced a hypersensitivity reaction and patient 2 experienced thrombocytopenia postoperatively. The average acquisition cost was $3,824 and the average retail price was $7,143 per complete dose.
PCC4 contributed to efficient reduction of International Normalized Ratio (INR) before surgery. PCC4 requires less volume than FFP for similar INR reductions. PCC4 was a beneficial agent in our patients with VADs; however, a cost-benefit analysis is needed to evaluate the future utility of PCC4.
描述在即将接受心脏移植且正在服用华法林的心室辅助装置（VAD）患者中使用四因子凝血酶原复合物浓缩剂（PCC4）的经验。
我们报告了一个临床病例系列，描述了4例VAD患者在心脏移植前接受PCC4治疗以逆转抗凝作用的情况。通过回顾性病历审查收集2014年3月27日至2014年7月20日的数据。
抗凝逆转的平均时间为2.45小时，PCC4的平均注射量为86毫升。没有患者发生血栓栓塞事件或血红蛋白下降提示出血事件。患者接受的红细胞、血小板和新鲜冰冻血浆（FFP）的平均量为2325毫升。患者1术后发生过敏反应，患者2术后发生血小板减少症。每完整剂量的平均采购成本为3824美元，平均零售价为7143美元。
PCC4有助于在手术前有效降低国际标准化比值（INR）。在降低相似INR时，PCC4所需的量比FFP少。PCC4对我们的VAD患者是一种有益的药物；然而，需要进行成本效益分析来评估PCC4未来的效用。
