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https://www.readbyqxmd.com/read/29785470/four-factor-prothrombin-complex-concentrate-for-warfarin-reversal-in-patients-with-left-ventricular-assist-devices
#1
Jessica Rimsans, Amy Levesque, Erin Lyons, Katelyn Sylvester, Michael M Givertz, Mandeep R Mehra, Garrick C Stewart, Jean M Connors
Continuous flow left ventricular assist devices (CF-LVAD) require therapeutic anticoagulation which is often interrupted for procedures or bleeding. Prior to the availability of four factor prothrombin complex concentrate (4F-PCC) in the United States, warfarin was held and its effects reversed by vitamin K or fresh frozen plasma. We evaluated the use of 4F-PCC for temporary warfarin reversal in patients with CF-LVADs and assessed outcomes. This analysis is a retrospective study of CF-LVAD patients who received 4F-PCC for warfarin reversal in the setting of bleeding or need for urgent or elective procedures...
May 21, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29706805/comparison-of-outcomes-in-patients-with-intracranial-hemorrhage-on-factor-xa-inhibitors-versus-vitamin-k-antagonists-treated-with-4-factor-prothrombin-complex-concentrate
#2
Sarah K Harrison, John S Garrett, Kelsey N Kohman, Jeffrey A Kline
The relative clinical efficacy of 4-factor prothrombin complex concentrate (4F-PCC) in oral anticoagulant-associated intracranial hemorrhage is unknown, especially for factor Xa-inhibiting anticoagulants. We report short-term outcomes of patients with oral anticoagulant-associated intracranial hemorrhage on vitamin K antagonists and factor Xa inhibitors who were treated with 4F-PCC. This multicenter, observational study involved patients presenting to the emergency department in nine hospitals in an integrated health care delivery system in Texas between July 2013 and December 2015...
April 2018: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/29619338/three-versus-four-factor-prothrombin-complex-concentrate-for-the-reversal-of-warfarin-induced-bleeding
#3
Tara Holt, Scott Taylor, Prasad Abraham, Wesley Mcmillian, Serena Harris, James Curtis, Tai Elder
Objective: The objective of this study was to evaluate the effectiveness of 3-factor prothrombin complex concentrate (3F-PCC) compared to 4-factor PCC (4F-PCC) in warfarin-associated bleeding. Methods: This multicenter, retrospective, cohort study analyzed data from patients admitted between May 2011 and October 2014 who received PCC for warfarin-associated bleeding. The primary outcome was the rate of international normalized ratio (INR) normalization, defined as an INR ≤1...
January 2018: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29611104/fixed-dose-4-factor-prothrombin-complex-concentrate-we-don-t-know-where-we-re-going-if-we-don-t-know-how-to-get-there
#4
REVIEW
Scott T Hall, Kyle C Molina
4-Factor Prothrombin Complex Concentrate (4F-PCC) is the standard-of-care intervention in patients with major bleeding taking oral vitamin K antagonists. Despite growing clinical experience with 4-FPCC, the optimal dosing strategy remains unclear. In balancing efficacy, safety, and cost of this treatment, many institutions have adopted a low, fixed-dose regimen, with average doses lower than that in the package insert. The fixed-dose 4F-PCC strategy is supported by the available observational studies and case reports; however, the current body of literature is highly heterogenous...
April 2, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29561270/low-dose-prothrombin-complex-concentrate-in-patients-with-left-ventricular-assist-devices
#5
Caitlin S Brown, Wesley R Zemrak, Kaitlin J Dyer, Stephen Rolfe
Left ventricular assist devices (LVADs) have become an important advancement for patients with end-stage heart failure. Left ventricular assist devices come with the risk of stroke and pump thrombosis, and to mitigate these risks, anticoagulation is given to these patients. With anticoagulation comes increased bleeding risk, and urgent reversal may be necessary. Reports have shown that the risk of thrombosis with prothrombin complex concentrate (PCC) does exist, especially in patients with baseline risk factors for thrombosis...
March 20, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29366484/discussion-of-protocolized-warfarin-reversal-with-4-factor-prothrombin-complex-concentrate-versus-3-factor-prothrombin-complex-concentrate-with-recombinant-factor-viia
#6
Rachel Van Dusen
INTRODUCTION: Life-threatening bleeding is the most feared complication of warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin K dependent clotting factors is essential for hemostasis. METHODS: A retrospective cohort study of warfarin-treated patients experiencing a life-threatening bleed treated with a warfarin reversal protocol comprised of 4F PCC (post-implementation group) and those who received the prior reversal protocol of 3F PCC and rFVIIa (pre-implementation group) was performed...
January 5, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29338845/protocolized-warfarin-reversal-with-4-factor-prothrombin-complex-concentrate-versus-3-factor-prothrombin-complex-concentrate-with-recombinant-factor-viia
#7
Cassie A Barton, Marissa Hom, Nathan B Johnson, Jon Case, Ran Ran, Martin Schreiber
INTRODUCTION: Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal. METHODS: A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded...
January 5, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29317397/factors-associated-with-availability-of-anticoagulation-reversal-agents-in-rural-and-community-emergency-departments
#8
Brett A Faine, Julie Amendola, Jordan Homan, Azeemuddin Ahmed, Nicholas Mohr
PURPOSE: Results of a study of anticoagulation reversal agent availability in rural and community hospital emergency departments (EDs) are reported. METHODS: A cross-sectional telephone survey was conducted to test the hypothesis that anticoagulation reversal agents are not commonly stocked in low-volume EDs. In phase 1 of the study, a physician, pharmacist, or nurse manager at a sample of EDs in 1 state was surveyed to characterize anticoagulation reversal agent availability and the presence or absence of reversal protocols; in phase 2, follow-up qualitative interviews were conducted with hospital pharmacists selected by purposive sampling to identify barriers to availability...
January 15, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29278982/the-use-of-kcentra-%C3%A2-in-the-reversal-of-coagulopathy-of-chronic-liver-disease
#9
Deepika Pereira, Eric Liotta, Ahmed A Mahmoud
We aim to describe our experience with the four-factor prothrombin complex concentrates (4F-PCC) Kcentra® at differing doses in patients with liver cirrhosis requiring emergent hemostasis in the setting of major or life-threatening bleeding. An automated query of patients who received Kcentra between January 2014 and March 2016 was performed. Patients who had clinically significant bleeding and received Kcentra for treatment of coagulopathy of chronic liver disease (CCLD) were included in the study. Baseline patient demographics, administration indication, pertinent laboratory values, and other reversal therapies were collected...
February 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29262430/reversal-of-oral-anticoagulants-for-intracerebral-hemorrhage-patients-best-strategies
#10
Lanting Fuh, Jonathan H Sin, Joshua N Goldstein, Bryan D Hayes
In patients with acute intracerebral hemorrhage (ICH), one of the major concerns is ongoing bleeding or ICH expansion. Anticoagulated patients are at higher risk of ongoing expansion and worse outcome. It may be that rapid anticoagulation reversal can reduce the risk of expansion and improve clinical outcome. For those taking coumarins, the best available evidence suggests that intravenous vitamin K combined with four-factor prothrombin complex concentrate (4F-PCC) is the most rapid and effective regimen to restore hemostasis...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29198634/intraoperative-administration-of-4-factor-prothrombin-complex-concentrate-reduces-blood-requirements-in-cardiac-transplantation
#11
Gina H Sun, Visal Patel, Ingrid Moreno-Duarte, Farhad Zahedi, Eric Ursprung, Greg Couper, Fred Y Chen, Ian J Welsby, Raymond Comenzo, Grace Kao, Frederick C Cobey
OBJECTIVE: Assessing the efficacy of intraoperative 4-factor prothrombin complex concentrate (4F-PCC) use in blood product utilization, time to chest closure, intensive care unit (ICU) and hospital length of stay (LOS), thromboembolic complications, renal injury and mortality in left ventricular assist device (LVAD) patients on home anticoagulation therapy with warfarin, undergoing orthotopic heart transplantation (OHT). DESIGN: Retrospective analysis of OHT patients at Tufts Medical Center from May 2013 to October 2016...
February 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29106076/rivaroxaban-reversal-with-prothrombin-complex-concentrate-or-tranexamic-acid-in-healthy-volunteers
#12
J H Levy, K T Moore, M D Neal, D Schneider, V S Marcsisin, J Ariyawansa, J I Weitz
Essentials Specific reversal agents for managing severe factor Xa inhibitor-associated bleeding are lacking. We assessed 4-factor-prothrombin complex concentrate (4F-PCC) and tranexamic acid (TXA). 4F-PCC, but not TXA, reduced the prothrombin time and increased endogenous thrombin potential. These agents may be viable options for reversal of therapeutic doses of rivaroxaban. SUMMARY: Background Oral activated factor X inhibitors such as rivaroxaban are widely used, but specific reversal agents are lacking...
January 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29057123/four-factor-prothrombin-complex-concentrate-reduces-time-to-procedure-in-vitamin-k-antagonist-treated-patients-experiencing-gastrointestinal-bleeding-a-post-hoc-analysis-of-two-randomized-controlled-trials
#13
Majed A Refaai, Truptesh H Kothari, Shana Straub, Jacob Falcon, Ravi Sarode, Joshua N Goldstein, Andres Brainsky, Laurel Omert, Martin L Lee, Truman J Milling
INTRODUCTION: To investigate the impact of a 4-factor prothrombin complex concentrate (4F-PCC [Beriplex®/Kcentra®]) versus plasma on "time to procedure" in patients with acute/severe gastrointestinal bleeding requiring rapid vitamin K antagonist (VKA) reversal prior to invasive procedure. METHODS: A post hoc analysis of two phase III trials of 4F-PCC versus plasma in patients with acute/severe gastrointestinal bleeding. The treatment arms were compared for study treatment volume, infusion times, and time from start of study treatment to procedure...
2017: Emergency Medicine International
https://www.readbyqxmd.com/read/28815410/efficacy-and-safety-of-a-4-factor-prothrombin-complex-concentrate-for-rapid-vitamin-k-antagonist-reversal-in-japanese-patients-presenting-with-major-bleeding-or-requiring-urgent-surgical-or-invasive-procedures-a-prospective-open-label-single-arm-phase-3b-study
#14
MULTICENTER STUDY
Shigeki Kushimoto, Toshio Fukuoka, Akio Kimura, Kazunori Toyoda, Andres Brainsky, Amy Harman, Thomas Chung, Masahiro Yasaka
Rapid vitamin K antagonist (VKA) reversal is required in patients experiencing major bleeding or requiring urgent surgery. Four-factor prothrombin complex concentrate (4F-PCC; Beriplex® /Kcentra® ) was shown in two large randomized controlled, international phase 3b trials to be an effective alternative to plasma for urgent VKA reversal. In the present prospective, open-label, single-arm phase 3b trial, we evaluate the efficacy and safety of 4F-PCC in Japanese patients. Eleven patients [international normalized ratio (INR) ≥2] requiring rapid VKA reversal owing to major bleeding (n = 6) or before urgent surgical/invasive procedures (n = 5) were administered 4F-PCC dosed based on INR and weight...
December 2017: International Journal of Hematology
https://www.readbyqxmd.com/read/28660341/low-dose-prothrombin-complex-concentrate-for-warfarin-associated-intracranial-hemorrhage-with-inr-less-than-2-0
#15
Wesley R Zemrak, Kathryn E Smith, Stephen S Rolfe, Teresa May, Robert L Trowbridge, Timothy L Hayes, Gene A Grindlinger, David B Seder
BACKGROUND: Prothrombin complex concentrates (PCCs) have become the first-line therapy for warfarin reversal in the setting of central nervous system (CNS) hemorrhage. Randomized, controlled studies comparing agents for warfarin reversal excluded patients with international normalized ratio (INR) <2, yet INR values of 1.6-1.9 are also associated with poor outcomes. METHODS: We retrospectively reviewed our use of a low-dose (15 units/kg) strategy of 4-factor PCC (4F-PCC) on warfarin reversal (INR 1...
December 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28604569/use-of-four-factor-prothrombin-complex-concentrate-in-the-reversal-of-warfarin-induced-and-nonvitamin-k-antagonist-related-coagulopathy
#16
Hannah Young, Jeremy L Holzmacher, Richard Amdur, Stephen Gondek, Babak Sarani, Mary E Schroeder
: To evaluate the efficacy of international normalized ratio (INR) reversal using four-factor prothrombin complex concentrate (4F-PCC) in nonmedication-induced coagulopathy. We performed a single-site, retrospective cohort study of patients receiving off-label use of 4F-PCC. Cohorts included liver dysfunction if they had acute liver decompensation or cirrhosis without other causative factors of liver failure such as sepsis, coagulopathy of acute sepsis (CAS) if they had documentation of sepsis and no underlying liver disorder, known factor deficiencies, or medication-induced coagulopathy, or warfarin if they were taking warfarin...
October 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28469866/use-of-four-factor-prothrombin-complex-concentrate-for-the-mitigation-of-rivaroxaban-induced-bleeding-in-an-emergent-coronary-artery-bypass-graft
#17
Michael Liu, Cliff Aguele, Umer Darr
We presented the first case of four-factor prothrombin complex concentrate (4F-PCC) for the alleviation of bleeding for emergent on-pump coronary artery bypass graft (CABG) with the patient discharged by postoperative day (POD) 9 with no sequelae. Until direct antidotes are available, 4F-PCC may play a role in the management of mitigating rivaroxaban-induced bleeding in surgical procedure.
May 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28161220/comparison-of-the-safety-and-efficacy-between-3-factor-and-4-factor-prothrombin-complex-concentrates-for-the-reversal-of-warfarin
#18
COMPARATIVE STUDY
Julia E Kuroski, Sarah Young
PURPOSE: Prior to the Food and Drug Administration approval of 4-factor prothrombin complex concentrate (4F-PCC), only 3-factor PCC (3F-PCC) products were available in the US. There is limited data comparing the safety and efficacy of 3F-PCC versus 4F-PCC. The purpose of our study, therefore, was to compare the safety and efficacy profiles of 3F-PCC versus 4F-PCC for the emergent reversal of warfarin. METHODS: A single-center, retrospective cohort analysis compared patients who received 3F-PCC or 4F-PCC for the emergent reversal of warfarin due to life-threating bleeding from January 2013 to September 2015...
June 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27851164/1528-4f-pcc-demonstrates-favorable-efficacy-in-a-rabbit-model-of-coagulopathy-and-acute-bleeding
#19
Eva Herzog, Franz Kaspereit, Wilfried Krege, Baerbel Doerr, Marcel Mischnik, Ingo Pragst, Gerhard Dickneite
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27851140/1504-4f-pcc-demonstrates-favorable-safety-profile-in-a-rabbit-model-of-venous-thrombosis
#20
Eva Herzog, Franz Kaspereit, Wilfried Krege, Baerbel Doerr, Marcel Mischnik, Ingo Pragst, Gerhard Dickneite
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
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