Safety and effectiveness of a prothrombin complex concentrate in approved and off-label indications
Marcos-Jubilar M (1), García Erce JA (2), Martínez-Calle N (3), Páramo JA (1), Martínez Virto A (4), Quintana-Díaz M (5)
(1) Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.
(2) Banco de Sangre y Tejidos de Navarra, Pamplona, Spain.
(3) Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
(4) Emergency Department, Hospital Universitario La Paz, Madrid, Spain.
(5) Intensive Medicine, Hospital Universitario La Paz, Madrid, Spain.
To evaluate the effectiveness and safety of prothrombin complex concentrates (PCCs) in approved and off-label indications.
PCCs are approved for the urgent reversal of vitamin K antagonists (VKAs). Data concerning the efficacy, safety and dosing for off-label indications are limited, but they are included in massive bleeding protocols.
This was a retrospective review of cases treated with four-factor PCCs (4F-PCCs) between January 2009 and 2016. Efficacy end-points include: (i) VKA reversal efficacy assessed by international normalised ratio (INR) normalisation (<1·5) and (ii) clinical efficacy as bleeding cessation and/or decreased number of transfused blood components and 24-h mortality in bleeding coagulopathy. The safety end-point is the incidence of thromboembolic events.
A total of 328 patients were included (51·8% male, median age 78 years old). Indications were as follows: VKA reversal (66·6%), bleeding coagulopathy (30·5%) and direct anticoagulant (DOAC) reversal due to bleeding (2·5%). VKA reversal was effective in 97·1% of patients, and 76·5% demonstrated complete reversal (INR < 1·5); only 34·3% patients needed hemoderivatives. Prior to emergency procedures, PCCs achieved global responses in 83% of patients, with no bleeding complication during intervention. DOAC reversal was effective in 88·9% of patients. Bleeding cessation was associated with the dose administered (P = 0·002). In coagulopathy bleeding, haemorrhage cessation, established by the International Society of Thrombosis and Haemostais (ISTH) definition, occurred in 56·7% of massive bleeding events and in 42·5% of other coagulopathies; 24-h mortality was 30%, mainly related to active bleeding. Ten thrombotic episodes were observed (3·1%).
4F-PCC was effective as adjuvant treatment with an acceptable safety profile, not only for the emergent reversal of VKAs but also for refractory coagulopathy associated with major bleeding.
CITATION Transfus Med. 2019 Jul 25. doi: 10.1111/tme.12621