Our findings indicate that LDrFVIIa (1000 or 1200 mcg) is more effective at reversing the INR compared to PCC3 (20 units/kg) as evident by more patients achieving an INR of 1.5 or less. Furthermore, only one patient receiving LDrFVIIa required a second dose for additional warfarin reversal, compared to 16 PCC3 patients who received a second dose, all of these due to failure of the first dose to effectively reverse the INR to 1.5 or less. There was no difference in mortality or thromboembolic complications, although the small sample size makes this difficult to interpret. Further, no association can be made from this
data as to whether the thromoboembolic events were the result of the coagulation factor administered independent of other existing risk factors for thromboembolic events. Prothrombin complex concentrate products are derived from purified pooled human plasma. All PCC products contain factors II, IX, and X along with variable amounts of factor #10058-F4 in vitro randurls[1|1|,|CHEM1|]# VII. Some PCC products, referred to as 4 factor PCC, contain larger amounts of factor VII (36–100 I.U. per 100 I.U. factor IX) compared
to PCC3 products, that contain relatively low amounts of factor VII (0–25 I.U. per 100 I.U. factor IX) . Both PCC3 products (dosed at 12–50 units/kg) and 4 factor PCC products (dosed at 7–50 units/kg) have been reported to provide rapid reversal of the INR . Two PCC products available Smad inhibitor in the United States (Profilnine® SD and Bebulin® VH) are PCC3 products. Give the absence of a standardized dosing regimen at the
time of this work and the wide range of doses of PCC reported in the literature, we chose 20 units/kg as an initial PCC dose with recommendations to repeat the INR post-PCC3 administration. A 4 factor PCC product available in Europe has completed clinical trials and has recently selleck inhibitor been approved by the FDA (Kcentra®) for warfarin reversal in patients with acute major bleeding. When compared with plasma, this 4 factor PCC product was found to be non-inferior at achieving hemostasis at 24 hours (72.4% vs. 65.4%) and superior at achieving rapid correction of INR to 1.3 or less at 30 minutes (62.2% vs. 9.6%). The recommended dosing strategy for this product is 25–50 units/kg based on patient weight and baseline INR . The fixed dosing used in our patients may have contributed to the results of fewer patients achieving the goal INR of 1.5 or less. A recent evaluation of PCC3 found suboptimal reversal of warfarin in patients with an INR greater than 5. The INR was reversed to less than 3 in 50% of patients receiving PCC3 25 units/kg and 43% of patients receiving PCC 50 units/kg. Transfusion of additional FFP (mean of 2.1) was required to provide further INR lowering to below 3, resulting in 89% and 88% of patients in the 25 U/kg and 50 U/kg groups achieving that INR goal, respectively . Imberti et al. used a PCC3 administered at 35–50 units/kg in patients with ICH effectively reversed the INR from a mean of 3.5 (range 2.0–9.0) to 1.