Scott Rachael, Kersten Brian, Basior Jeanne, Nadler Megan
Buffalo General Medical Center, Buffalo, New York.
Department of Emergency Medicine, University at Buffalo/Buffalo General Medical Center, Buffalo, New York.
J Emerg Med. 2018 Jun;54(6):861-866. doi: 10.1016/j.jemermed.2018.01.030. Epub 2018 Mar 3.
Different strategies exist for dosing four-factor prothrombin complex concentrate (PCC4) for international normalized ratio (INR) reversal in the setting of life-threatening bleeding. Fixed doses ranging from 1000 IU to 1750 IU have demonstrated efficacy similar to weight-based dosing, however, few studies look exclusively at intracranial hemorrhage (ICH).
Our aim was to evaluate whether a fixed dose of 1000 IU of PCC4 achieves INR reversal similar to weight-based dosing in patients with ICH who were anticoagulated with warfarin.
We compared a weight-based dose vs. 1000 IU PCC4 between January 2014 and January 2017. The primary end point was achieving an INR < 1.5. Secondary end points included in-hospital mortality, patient disposition, and reversal defined by INR < 1.6.
A total of 31 patients were included in the weight-based group and 30 were included in the fixed-dose group, with baseline INRs of 2.98 and 2.84, respectively (p = 0.39). Twenty-two patients (71%) achieved an INR < 1.5 in the weight-based group vs. 16 (53%) in the fixed-dose group (p = 0.15), while 25 (81%) achieved an INR < 1.6 in the weight-based group vs. 22 (73%) in the fixed-dose group (p = 0.49). There was no difference in the number of patients discharged to home (19% vs. 20%; p = 0.95) or in-hospital mortality (26% vs. 27%; p = 0.93).
We found a non-statistically significant difference in warfarin reversal to an INR goal of < 1.5 when comparing a fixed dose of 1000 IU PCC4 and a weight-based dose for ICH. Further studies correlating clinical outcomes with INR reversal are needed.
在危及生命的出血情况下，存在多种用于国际标准化比值（INR）逆转的四因子凝血酶原复合物浓缩剂（PCC4）给药策略。1000国际单位至1750国际单位的固定剂量已证明其疗效与基于体重的给药相似，然而，很少有研究专门针对颅内出血（ICH）。
我们的目的是评估在使用华法林抗凝的ICH患者中，1000国际单位的固定剂量PCC4是否能实现与基于体重的给药相似的INR逆转。
我们比较了2014年1月至2017年1月期间基于体重的剂量与1000国际单位PCC4。主要终点是使INR<1.5。次要终点包括院内死亡率、患者处置情况以及INR<1.6定义的逆转情况。
基于体重的组共纳入31例患者，固定剂量组纳入30例患者，基线INR分别为2.98和2.84（p = 0.39）。基于体重的组中有22例患者（71%）实现INR<1.5，而固定剂量组中有16例（53%）（p = 0.15）；基于体重的组中有25例（81%）实现INR<1.6，固定剂量组中有22例（73%）（p = 0.49）。出院回家的患者数量（19%对20%；p = 0.95）或院内死亡率（26%对27%；p = 0.93）没有差异。
在比较1000国际单位PCC4的固定剂量和基于体重的剂量用于ICH时，我们发现将华法林逆转至INR目标<1.5时存在无统计学意义的差异。需要进一步开展将临床结局与INR逆转相关联的研究。
