Factors contributing to poor outcome in patients on warfarin receiving 4-factor prothrombin complex concentrate in critically ill

Ajay Kumar  Mishra; Kamal Kant  Sahu; Amos Lal; Susan V  George

doi:10.23750/abm.v92i5.9601

Factors contributing to poor outcome in patients on warfarin receiving 4-factor prothrombin complex concentrate in critically ill

Authors

Ajay Kumar Mishra Department of Internal Medicine Saint Vincent Hospital Worcester, Massachusetts USA, 01608
Kamal Kant Sahu Department of Internal Medicine Saint Vincent Hospital Worcester, Massachusetts USA, 01608
Amos Lal Division of Pulmonary and Critical Care Medicine 200 1st St, SW, Mayo Clinic, Rochester MN, USA https://orcid.org/0000-0002-0021-2033
Susan V George Department of Internal Medicine Saint Vincent Hospital, Worcester, Associate Professor of Medicine, University of Massachusetts Medical School Massachusetts USA, 01608

DOI: https://doi.org/10.23750/abm.v92i5.9601

Keywords:

Prothrombin complex concentrate, outcome, predictors

Abstract

Aim: To compare the demographical profile, indications, efficacy, and contributors to adverse outcome following administration of 4F-PCC in patients on warfarin with supratherapeutic INR.

Methodology: Retrospective cross-sectional study was performed in a community based teaching hospital. All patients 18 years and older on warfarin with supratherapeutic INR, who had received 4F-PCC between January 2014 and December 2018 were eligible and included in the study.

Results: 44 patients were included in the analysis. The mean age of the patients was 79.5 years. The male to female ratio was 1:1. Patients were on warfarin for atrial fibrillation, thromboembolism in 79.5% (N-35), and 20.5% (N-9) respectively. Indications for use of 4F-PCC were active bleeding in 93% (N-41) of patients. The common sites of bleeding were gastrointestinal, intracranial, and musculoskeletal which were seen in 54.5% (N-24), 29.5% (N-13) and 6.8% (N-3) respectively. The median number of doses of 4F-PCC administered was 1 per patient. The mean dose administered was 2,883u. Clinical improvement was documented in 84% (N-37) of patients. Mortality was seen in 16% (N-7) of patients. BMI greater than 30, anemia, hypotension, presence of intracranial bleed, the requirement of blood products, and mechanical ventilation were associated with higher odds for mortality. Hypotension and requirement of mechanical ventilation were statistically significant.

Conclusion: 4F-PCC continues to be an effective agent in the rapid reversal of warfarin therapy in patients with supratherapeutic INR presenting with major bleeding events. Most patients have clinical improvement with a single, weight-adjusted dose.

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