Department of Pharmacy, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
Am J Surg. 2018 May;215(5):775-779. doi: 10.1016/j.amjsurg.2017.12.011. Epub 2018 Jan 5.
Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal.
A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded.
195 patients were included in final analysis. While baseline demographics were similar between groups, the 3F-PCC group had a longer ICU LOS and higher in-hospital mortality (p < .01, .01). Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the 3F-PCC group, 0.8 versus 1.3 (p < .01). Significantly more patients experienced thromboembolic complications in the 3F-PCC group than the 4F-PCC group (p < .01). Receipt of rFVIIa was significantly associated with thromboembolic complications.
A 4F PCC reversal strategy is efficacious in INR reversal and provides lower thromboembolic risk as compared to 3F PCC with rFVIIa.
危及生命的出血可能使华法林治疗复杂化。通过替代维生素 K 依赖性凝血因子来快速逆转抗凝作用对于止血至关重要。我们比较了两种用于华法林逆转的快速因子替代方法。
对接受包含 4F PCC 或 3F PCC 和 rFVIIa 的逆转方案的华法林治疗患者发生危及生命的出血进行回顾性队列研究。记录人口统计学、临床和抗凝逆转信息，以及归因于华法林逆转的所有不良事件。
最终分析纳入 195 例患者。尽管两组的基线人口统计学特征相似，但 3F-PCC 组的 ICU LOS 更长，住院死亡率更高（p<0.01，p<0.01）。两组患者的预逆转 INR 相似，但 3F-PCC 组的 INR 明显更低，为 0.8 比 1.3（p<0.01）。3F-PCC 组发生血栓栓塞并发症的患者明显多于 4F-PCC 组（p<0.01）。接受 rFVIIa 的患者发生血栓栓塞并发症的风险显著增加。
与使用 3F PCC 和 rFVIIa 相比，4F PCC 逆转策略在 INR 逆转方面更有效，并降低血栓栓塞风险。
