University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
CSL Behring, King of Prussia, PA, USA.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231179682. doi: 10.1177/10760296231179682.
Real-world utilization of 4-factor prothrombin complex concentrate (4F-PCC) and plasma for the management of oral anticoagulant (OAC)-associated bleeding in US trauma hospitals was described.This is amulticenter, retrospective chart review evaluating the use of 4F-PCC and plasma in OAC reversal across medical specialties. Physicians completed a survey and extracted data from 3 to 5 patient charts. Variables of interest included medical specialty, urgency, and bleed type. Two hundred and thirty-five physicians completed the survey, and 861 patient charts were included in the study. 4F-PCC was commonly used in life-threatening or emergent indications, whereas plasma was used in emergent and urgent indications. Plasma was used mostly for patients on warfarin (53% vs 47% 4F-PCC) and 4F-PCC for those on apixaban (82% vs 18% plasma) and rivaroxaban (77% vs 23% plasma). This retrospective analysis showed that 4F-PCC was predominantly used for OAC reversal despite available specific reversal agents for some of the OAC. Although it is not recommended by any reversal guidelines, plasma is still used for OAC reversal. Plasma should be avoided in the management of OAC-associated bleeding.
描述了美国创伤医院中使用 4 因子凝血酶原复合物浓缩物（4F-PCC）和血浆治疗口服抗凝剂（OAC）相关出血的真实世界应用。这是一项多中心、回顾性图表审查，评估了在不同医学专业中使用 4F-PCC 和血浆逆转 OAC 的情况。医生完成了一项调查，并从 3 到 5 份患者图表中提取数据。感兴趣的变量包括医学专业、紧迫性和出血类型。235 名医生完成了调查，861 份患者图表纳入了研究。4F-PCC 常用于危及生命或紧急的情况下，而血浆则用于紧急和紧急情况下。对于华法林患者，主要使用血浆（53%比 47% 4F-PCC），而对于阿哌沙班和利伐沙班患者，主要使用 4F-PCC（82%比 18%血浆和 77%比 23%血浆）。这项回顾性分析表明，尽管有一些 OAC 的特定逆转剂，但 4F-PCC 主要用于 OAC 逆转。尽管没有任何逆转指南推荐，但仍在使用血浆进行 OAC 逆转。在 OAC 相关出血的管理中应避免使用血浆。
