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3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Severe Bleeding: A Multicenter, Retrospective, Propensity-Matched Pilot Study

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Abstract

Current guidelines recommend 4-factor prothrombin complex concentrate (4PCC) for emergent reversal of bleeding secondary to warfarin. While current research has demonstrated superiority of 4PCC over plasma, direct comparisons with 3-factor PCC (3PCC) are lacking. The purpose of this study is to compare the efficacy and safety of 3PCC and 4PCC. We conducted a retrospective analysis of patients who received PCC at one of four medical centers. All patients in the 3PCC group were treated at one center that utilizes a fixed, weight-based dosing protocol. After evaluation of all patients meeting inclusion criteria, propensity-score matching was used to adjust for differences in treatment characteristics. There was no difference in the primary outcome of INR ≤ 1.4 between 3PCC and 4PCC in both the unmatched (85.7 vs. 90.6 %; p = 0.37) and matched (84.2 vs. 92.1 %; p = 0.48) analyses. There was a significant difference in goal INR achieved favoring 4PCC (56.3 vs 90.0 %; p < 0.02) when baseline INR > 4.0. A total of three thrombotic events were documented, all in the 4PCC group. We found no difference in the rate of INR reversal in those treated with 3PCC and 4PCC. However, those with a baseline INR > 4.0 may experience more successful INR reversal with 4PCC.

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Abbreviations

3PCC:

3-Factor prothrombin complex concentrate

4PCC:

4-Factor prothrombin complex concentrate

FFP:

Fresh frozen plasma

INR:

International normalization ratio

IQR:

Interquartile range

PCC:

Prothrombin complex concentrate

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Acknowledgments

No funding was obtained for the conduction of this study. The results of this study have not been presented previously.

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Authors and Affiliations

  1. Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA

    G. Morgan Jones

  2. Department of Clinical Pharmacy, University of Tennessee Health Sciences Center (UTHSC), 920 Court Ave, Memphis, TN, 38163, USA

    G. Morgan Jones

  3. Department of Neurology and Neurosurgery, UTHSC, 920 Court Ave, Memphis, TN, 38163, USA

    G. Morgan Jones & Lucas Elijovich

  4. Department of Pharmacy, University of Florida Health, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Michael J. Erdman

  5. Department of Pharmacy, University of Kentucky HealthCare, 800 Rose St, Lexington, KY, 40536, USA

    Keaton S. Smetana

  6. Department of Pharmacy, Temple University Hospital, 3509 N Broad St, Philadelphia, PA, 19140, USA

    Kerry M. Mohrien

  7. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 620 W Lexington St, Baltimore, MD, 21201, USA

    Joseph E. Vandigo

  8. Semmes-Murphey Neurologic and Spine Institute, 6325 Humphreys Blvd, Memphis, TN, 38120, USA

    Lucas Elijovich

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  1. G. Morgan Jones
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Correspondence to G. Morgan Jones.

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All authors of this study have no direct or indirect conflict of interest to disclose.

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Jones, G.M., Erdman, M.J., Smetana, K.S. et al. 3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Severe Bleeding: A Multicenter, Retrospective, Propensity-Matched Pilot Study. J Thromb Thrombolysis 42, 19–26 (2016). https://doi.org/10.1007/s11239-015-1330-3

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