Loyola University Medical Center, Department of Pharmacy, Maywood, Illinois.
Stritch School of Medicine, Loyola University Chicago, Department of Emergency Medicine, Maywood, Illinois.
West J Emerg Med. 2021 Feb 26;22(2):163-169. doi: 10.5811/westjem.2020.11.47931.
Factor Xa (fXa) inhibitor reversal for life-threatening bleeding is controversial due to a lack of high-quality evidence. The purpose of this study was to determine the hemostatic efficacy of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of fXa inhibitors compared to warfarin for life-threatening bleeding.
This was a multicenter, retrospective cohort study at two academic medical centers between January 1, 2014-December 31, 2019, which included patients who presented to the emergency department with a life-threatening bleed necessitating anticoagulation reversal with 4F-PCC. The primary endpoint was achievement of hemostatic efficacy after 4F-PCC administration.
Of the 525 patients who had an order for 4F-PCC during the study period, 148 patients met the criteria for inclusion (n = 48 fXa inhibitor group; n = 100 warfarin group). Apixaban (52.1%) and rivaroxaban (45.8%) were the most commonly used fXa inhibitors. Effective hemostasis was similar between groups (79.2% fXa inhibitor group vs 85% warfarin group, p = 0.38). This was consistent across all types of bleeding. Thrombotic events were rare in both groups (2% vs 3%).
This multicenter, retrospective cohort study demonstrated that using 4F-PCC for treatment of life-threatening bleeding produced effective hemostasis in patients on fXa inhibitors and warfarin.
由于缺乏高质量的证据，针对危及生命的出血，使用因子 Xa（fXa）抑制剂逆转剂存在争议。本研究的目的是确定与华法林相比，四种凝血因子浓缩物（4F-PCC）在逆转危及生命的出血的 fXa 抑制剂方面的止血效果。
这是一项在 2014 年 1 月 1 日至 2019 年 12 月 31 日期间在两个学术医疗中心进行的多中心回顾性队列研究，纳入了因危及生命的出血而需要使用 4F-PCC 逆转抗凝治疗并就诊于急诊科的患者。主要终点是在使用 4F-PCC 后达到止血效果。
在研究期间，有 525 名患者的医嘱中包含 4F-PCC，其中 148 名患者符合纳入标准（n = 48 例 fXa 抑制剂组；n = 100 例华法林组）。阿哌沙班（52.1%）和利伐沙班（45.8%）是最常用的 fXa 抑制剂。两组的有效止血效果相似（fXa 抑制剂组 79.2% vs 华法林组 85%，p = 0.38）。这在所有类型的出血中都是一致的。两组的血栓事件均很少见（2% vs 3%）。
这项多中心回顾性队列研究表明，使用 4F-PCC 治疗危及生命的出血可使接受 fXa 抑制剂和华法林治疗的患者有效止血。
