Keric Adis, Scheel Cole R, Asche Stephen E, Woster Casey, Stanfield Stephen
Regions Hospital, Saint Paul, MN, USA.
Methodist Hospital, Saint Louis Park, MN, USA.
Hosp Pharm. 2025 Feb 21:00185787251321073. doi: 10.1177/00185787251321073.
One option recommended by expert guidelines for prompt reversal of anticoagulation-induced hemorrhage is four-factor prothrombin complex concentrate (4F-PCC). Pharmacist presence has been shown to reduce order entry to administration and door-to-needle (DTN) times. However, how pharmacist preparation of 4F-PCC at the bedside in the Emergency Department (ED) can affect times to administration has not been thoroughly studied. The purpose of this study was to assess if pharmacist presence along with preparation of 4F-PCC at the bedside could improve administration times. This retrospective cohort study included anticoagulated patients requiring emergent reversal with 4F-PCC in the ED from January 2019 to April 2020 (pre-group) to March 2022 to March 2023 (post-group). Patients in the post-intervention group who had 4F-PCC prepared at the bedside were compared to a historical group without bedside 4F-PCC preparation. The primary outcome was time from 4F-PCC order entry to administration. Of 193 patients evaluated, 99 (51.3%) were included (N = 41 pre-group; N = 58 post-group). There was a significant 11 minute difference in median time from order entry to administration favoring the post-group (31 vs 20 minutes, < .001). The subset of patients with intracranial hemorrhage (ICH) in the post-group also had a significantly shorter order to administration time of 14 minutes (31 vs 17 minutes, < .001). There was no difference in overall DTN times, in-hospital mortality, or length of stay (LOS) between groups, including in the subset of patients with ICH. 4F-PCC preparation at the bedside by the ED pharmacist significantly reduced 4F-PCC order entry to administration time. However, this intervention did not reduce overall DTN times.
专家指南推荐的用于迅速逆转抗凝所致出血的一种选择是四因子凝血酶原复合物浓缩物（4F-PCC）。已证明药剂师在场可减少从医嘱录入到给药以及从入院到用药（DTN）的时间。然而，急诊科（ED）床边药剂师配制4F-PCC如何影响给药时间尚未得到充分研究。本研究的目的是评估药剂师在场并在床边配制4F-PCC是否能缩短给药时间。这项回顾性队列研究纳入了2019年1月至2020年4月（前组）至2022年3月至2023年3月（后组）在ED需要用4F-PCC紧急逆转抗凝的患者。将床边配制4F-PCC的干预后组患者与未进行床边4F-PCC配制的历史组进行比较。主要结局是从4F-PCC医嘱录入到给药的时间。在193例接受评估的患者中，99例（51.3%）被纳入（前组N = 41；后组N = 58）。从医嘱录入到给药的中位时间在后组有显著的11分钟差异（31分钟对20分钟，< 0.001），后组更具优势。后组颅内出血（ICH）患者亚组的医嘱到给药时间也显著缩短了14分钟（31分钟对17分钟，< 0.001）。两组之间的总体DTN时间、住院死亡率或住院时间（LOS）没有差异，包括ICH患者亚组。急诊科药剂师在床边配制4F-PCC显著缩短了4F-PCC从医嘱录入到给药的时间。然而，这项干预并未缩短总体DTN时间。
