Department of Pharmacy, 159947NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
Department of Pharmacy, 159947NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA.
J Intensive Care Med. 2020 Nov;35(11):1203-1208. doi: 10.1177/0885066619840992. Epub 2019 Apr 14.
Current guidelines favor 4F-PCC over plasma for reversal of warfarin. Uncertainty remains on the hemostatic effectiveness and thrombotic risk of 4F-PCC for direct-acting oral anticoagulants (DOACs), particularly in patients with intracranial hemorrhage (ICH). This study sought to evaluate the effectiveness and safety of a lower dose protocol of 25 units/kg 4F-PCC for the management of DOAC-associated ICH in a real-world setting.
This was a retrospective study of adult patients who received at least one dose of 4F-PCC from March 2014 to December 2015 for DOAC-associated ICH. The primary outcome was hemostatic effectiveness within 24 hours. The secondary outcome was thromboembolic events within 14 days.
Twenty-two patients received 4F-PCC for DOAC-associated ICH and were included in the analysis. Hemostasis was evaluable in 19 patients with post-4F-PCC imaging available and occurred in 18/19 (94.7%) patients. Thromboembolism occurred in 2 out of 22 patients (9.1%).
The use of a lower dose protocol of 25 units/kg of 4F-PCC resulted in high rates of hemostasis in patients with DOAC-associated ICH. Two patients developed thrombotic events within 14 days of 4F-PCC administration.
目前的指南倾向于使用 4F-PCC 而非血浆来逆转华法林。对于直接作用的口服抗凝剂（DOAC），4F-PCC 的止血效果和血栓形成风险仍存在不确定性，尤其是在颅内出血（ICH）患者中。本研究旨在评估在真实环境中使用较低剂量（25 单位/公斤）4F-PCC 治疗 DOAC 相关 ICH 的有效性和安全性。
这是一项回顾性研究，纳入了 2014 年 3 月至 2015 年 12 月期间因 DOAC 相关 ICH 接受至少一剂 4F-PCC 治疗的成年患者。主要结局是 24 小时内的止血效果。次要结局是 14 天内的血栓栓塞事件。
22 例患者因 DOAC 相关 ICH 接受了 4F-PCC 治疗，并纳入了分析。19 例患者在接受 4F-PCC 治疗后有影像学资料，其中 18 例（94.7%）止血有效。22 例患者中有 2 例（9.1%）发生血栓栓塞事件。
使用较低剂量（25 单位/公斤）的 4F-PCC 方案可使 DOAC 相关 ICH 患者获得较高的止血率。有 2 例患者在接受 4F-PCC 治疗后 14 天内发生血栓栓塞事件。
