Activated prothrombin complex concentrates for direct oral anticoagulant-associated bleeding or urgent surgery: Hemostatic and thrombotic outcomes.

Abstract

INTRODUCTION:

Studies evaluating the use of activated prothrombin complex concentrates (aPCCs) for DOAC-associated bleeding are sparse.

MATERIALS AND METHODS:

We conducted a retrospective study of patients receiving aPCC for DOAC-associated bleeding or for pre-operative optimization of hemostasis prior to urgent surgery. The primary efficacy outcome was hemostatic efficacy, the primary safety outcome was the 30-day thromboembolic complication rate.

RESULTS:

Eighty-two patients were included in the analysis; 14 patients on dabigatran, 39 patients on rivaroxaban and 29 patients on apixaban. Fifty-four patients received aPCC for major bleeding and 28 patients prior to urgent surgery. Mean aPCC dosing was 2974 IU (SD ± 857 IU). Hemostasis was deemed effective by ISTH criteria in 50% of cases and "Good" or "Moderate" by Sarode criteria in 45.2% and 14.3% of cases, respectively. Surgical hemostasis was rated as "Normal" in 84% of cases pre-operative administration. Median pre-aPCC INR was 1.6 (IQR 0.5) and median post-aPCC INR was 1.2 (IQR 0.2) (p < 0.00001). Median pre-aPCC aPTT was 36 s (IQR 12.8), median post-aPCC aPTT was 29 s (IQR 9.8) (p = 0.0001). The 30-day thromboembolic event rate was 6.1%.

CONCLUSION:

Further study is needed to characterize the hemostatic effects and thromboembolic risk of aPCC among patients with DOAC-associated bleeding or for attempted normalization of hemostasis prior to urgent surgery.

• Authors: Joseph R Shaw, Marc Carrier, Dar Dowlatshahi, Santanu Chakraborty, Melanie Tokessy, Hakan Buyukdere, Lana A Castellucci
• Journal: Thrombosis research (Thromb Res) Vol. 195 Pg. 21-28 (11 2020) ISSN: 1879-2472 [Electronic] United States
• PMID: 32645667 (Publication Type: Journal Article)
• Copyright: Copyright © 2020. Published by Elsevier Ltd.

Chemical References

• Anticoagulants
• Blood Coagulation Factors
• Hemostatics
• prothrombin complex concentrates
• Rivaroxaban
• Dabigatran

Topics

• Administration, Oral
• Anticoagulants (adverse effects)
• Blood Coagulation Factors
• Dabigatran
• Hemorrhage (chemically induced, drug therapy)
• Hemostasis
• Hemostatics
• Humans
• Retrospective Studies
• Rivaroxaban