Department of Haematology, Waitemata District Health Board, Auckland, New Zealand.
Intern Med J. 2021 Nov;51(11):1884-1890. doi: 10.1111/imj.14993. Epub 2021 Oct 23.
Reversal of warfarin with prothrombin complex concentrates (PCC) is required in cases of significant bleeding or need for urgent surgery. A weight-based regimen is commonly, but a fixed-dose approach is also feasible with clinically equivalent outcomes. The purpose of this audit is to review the clinical and laboratory outcomes of patients treated in our centre where fixed-dose PCC is used for warfarin reversal.
The primary objective was to evaluate the post-reversal international normalised ratio (INR). The secondary objectives were the proportion of patients requiring repeat PCC and 30-day complication rates (death, haemorrhage and thrombosis). A subgroup analysis was also performed to compare the outcomes of those who received a dose of ≤15 IU/kg (reduced dose) with those who received >15 IU/kg (standard dose).
Patients who received three-factor PCC for warfarin reversal between 1 January and 31 December 2016 were identified and analysed. Clinical data and PCC dosages were extracted from electronic patient records.
A total of 144 patients were analysed. The median INR pre-reversal was 3.25 (range 1.4-10), which reduced to 1.5 (0.9-3.0) post-reversal. Eighty-seven percent of patients achieved a post-reversal INR of less than 2 and 55% less than 1.5. Sixteen patients required a repeat dose. Complications occurred in 22 (15.3%) patients, which consisted of 15 deaths, 7 thrombosis and 2 haemorrhage. No statistically significant differences in the primary and secondary outcomes were noted between reduced-dose and standard-dose subgroups.
Our results support the use of fixed-dose PCC for warfarin reversal in a day-to-day clinical practice in a hospital setting.
在发生大出血或需要紧急手术的情况下，需要使用凝血酶原复合物浓缩物（PCC）逆转华法林的作用。通常采用基于体重的方案，但也可以采用固定剂量的方法，且临床结果相当。本次审核的目的是审查我们中心使用固定剂量 PCC 逆转华法林的患者的临床和实验室结果。
主要目标是评估逆转后国际标准化比值（INR）。次要目标是需要重复使用 PCC 的患者比例和 30 天并发症发生率（死亡、出血和血栓形成）。还进行了亚组分析，以比较接受 ≤15IU/kg 剂量（低剂量）和接受 >15IU/kg 剂量（标准剂量）的患者的结果。
确定并分析了 2016 年 1 月 1 日至 12 月 31 日期间接受三因子 PCC 逆转华法林的患者。从电子病历中提取临床数据和 PCC 剂量。
共分析了 144 名患者。逆转前 INR 的中位数为 3.25（范围 1.4-10），逆转后降至 1.5（0.9-3.0）。87%的患者逆转后 INR 小于 2，55%的患者 INR 小于 1.5。16 名患者需要重复剂量。22 名（15.3%）患者发生并发症，包括 15 例死亡、7 例血栓形成和 2 例出血。在低剂量和标准剂量亚组中，主要和次要结局没有统计学上的显著差异。
我们的结果支持在医院环境的日常临床实践中使用固定剂量的 PCC 逆转华法林。
