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Four factor prothrombin complex concentrate for warfarin reversal in patients with left ventricular assist devices

Authors :
Amy A Levesque
Jessica Rimsans
E.N. Lyons
Mandeep R. Mehra
Jean M. Connors
Michael M. Givertz
Katelyn W. Sylvester
Garrick C. Stewart
Source :
Journal of Thrombosis and Thrombolysis. 46:180-185
Publication Year :
2018
Publisher :
Springer Science and Business Media LLC, 2018.

Abstract

Continuous flow left ventricular assist devices (CF-LVAD) require therapeutic anticoagulation which is often interrupted for procedures or bleeding. Prior to the availability of four factor prothrombin complex concentrate (4F-PCC) in the United States, warfarin was held and its effects reversed by vitamin K or fresh frozen plasma. We evaluated the use of 4F-PCC for temporary warfarin reversal in patients with CF-LVADs and assessed outcomes. This analysis is a retrospective study of CF-LVAD patients who received 4F-PCC for warfarin reversal in the setting of bleeding or need for urgent or elective procedures. Primary outcome assessments included feasibility of administration in elective versus emergent situations, safety measured as incidence of thrombotic events, and change in INR after administration. In total, 37 CF-LVAD patients received 49 4F-PCC administrations. The average 4F-PCC dose was 1842 units (range 518–4292 units), or 22 units/kg (range 5.8–58 units/kg). 4F-PCC significantly decreased the mean INR from 2.9 to 1.7 (p

Details

ISSN :
1573742X and 09295305
Volume :
46
Database :
OpenAIRE
Journal :
Journal of Thrombosis and Thrombolysis
Accession number :
edsair.doi.dedup.....5a840e3a01cdf12305bd18800c6237ea
Full Text :
https://doi.org/10.1007/s11239-018-1680-8