Propensity score adjusted comparison of three-factor versus four-factor prothrombin complex concentrate for emergent warfarin reversal: a retrospective cohort study
Dublin Core
Title
Propensity score adjusted comparison of three-factor versus four-factor prothrombin complex concentrate for emergent warfarin reversal: a retrospective cohort study
Subject
Anticoagulants, Hemostasis, Hemorrhage, Warfarin, Blood coagulation factors
Description
Background: Prothrombin Complex Concentrates (PCC) are prescribed for emergent warfarin reversal (EWR). The
comparative effectiveness and safety among PCC products are not fully understood.
Methods: Patients in an academic level one trauma center who received PCC3 or PCC4 for EWR were identified.
Patient characteristics, PCC dose and time of dose, pre- and post-INR and time of measurement, fresh frozen
plasma and vitamin K doses, and patient outcomes were collected. Patients whose pre-PCC International
Normalized Ratio (INR) was > 6 h before PCC dose or the pre-post PCC INR was > 12 h were excluded. The primary
outcome was achieving an INR ≤ 1.5 post PCC. Secondary outcomes were the change in INR over time, post PCC
INR, thromboembolic events (TE), and death during hospital stay. Logistic regression modelled the primary
outcome with and without a propensity score adjustment accounting for age, sex, actual body weight, dose, initial
INR value, and time between INR measurements. Data are reported as median (IQR) or n (%) with p < 0.05
considered significant.
Results: Eighty patients were included (PCC3 = 57, PCC4 = 23). More PCC4 patients achieved goal INR (87.0% vs.
31.6%, odds ratio (OR) = 14.4, 95% CI: 3.80–54.93, p < 0.001). This result remained true after adjusting for possible
confounders (AOR = 10.7, 95% CI: 2.17–51.24, p < 0.001). The post-PCC INR was lower in the PCC4 group (1.3 (1.3–
1.5) vs. 1.7 (1.5–2.0)). The INR change was greater for PCC4 (2.3 (1.3–3.3) vs. 1.1 (0.6–2.0), p = 0.003). Death during
hospital stay (p = 0.52) and TE (p = 1.00) were not significantly different.
Conclusions: PCC4 was associated with a higher achievement of goal INR than PCC3. This relationship was
observed in the unadjusted and propensity score adjusted results.
comparative effectiveness and safety among PCC products are not fully understood.
Methods: Patients in an academic level one trauma center who received PCC3 or PCC4 for EWR were identified.
Patient characteristics, PCC dose and time of dose, pre- and post-INR and time of measurement, fresh frozen
plasma and vitamin K doses, and patient outcomes were collected. Patients whose pre-PCC International
Normalized Ratio (INR) was > 6 h before PCC dose or the pre-post PCC INR was > 12 h were excluded. The primary
outcome was achieving an INR ≤ 1.5 post PCC. Secondary outcomes were the change in INR over time, post PCC
INR, thromboembolic events (TE), and death during hospital stay. Logistic regression modelled the primary
outcome with and without a propensity score adjustment accounting for age, sex, actual body weight, dose, initial
INR value, and time between INR measurements. Data are reported as median (IQR) or n (%) with p < 0.05
considered significant.
Results: Eighty patients were included (PCC3 = 57, PCC4 = 23). More PCC4 patients achieved goal INR (87.0% vs.
31.6%, odds ratio (OR) = 14.4, 95% CI: 3.80–54.93, p < 0.001). This result remained true after adjusting for possible
confounders (AOR = 10.7, 95% CI: 2.17–51.24, p < 0.001). The post-PCC INR was lower in the PCC4 group (1.3 (1.3–
1.5) vs. 1.7 (1.5–2.0)). The INR change was greater for PCC4 (2.3 (1.3–3.3) vs. 1.1 (0.6–2.0), p = 0.003). Death during
hospital stay (p = 0.52) and TE (p = 1.00) were not significantly different.
Conclusions: PCC4 was associated with a higher achievement of goal INR than PCC3. This relationship was
observed in the unadjusted and propensity score adjusted results.
Creator
David J. Margraf, Scott Seaburg, Gregory J. Beilman, Julian Wolfson, Jonathan C. Gipson and Scott A. Chapman
Publisher
BMC Emergency Medicine
Date
(2020) 20:93
Contributor
Fajar bagus W
Format
PDF
Language
Indonesia
Type
Text
Files
Collection
Citation
David J. Margraf, Scott Seaburg, Gregory J. Beilman, Julian Wolfson, Jonathan C. Gipson and Scott A. Chapman, “Propensity score adjusted comparison of three-factor versus four-factor prothrombin complex concentrate for emergent warfarin reversal: a retrospective cohort study,” Repository Horizon University Indonesia, accessed April 29, 2025, https://repository.horizon.ac.id/items/show/3586.