Comparison of 3-factor versus 4-factor prothrombin complex concentrate for emergent warfarin reversal: a systematic review and meta-analysis

Patients requiring emergent warfarin reversal (EWR) have been prescribed three-factor prothrombin complex concentrate (PCC3) and four-factor prothrombin complex concentrate (PCC4) to reverse the anticoagulant effects of warfarin. There is no existing systematic review and meta-analysis of studies di...

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Bibliographic Details
Published in:BMC emergency medicine 2022-01, Vol.22 (1), p.14-14, Article 14
Main Authors: Margraf, David J, Brown, Sarah J, Blue, Heather L, Bezdicek, Tamara L, Wolfson, Julian, Chapman, Scott A
Format: Article
Language:English
Subjects:
Anticoagulants
Anticoagulants - adverse effects
Blood Coagulation Factors
Data collection
Drug dosages
Emergency medical care
Estimates
FDA approval
Hemorrhage
Heterogeneity
Humans
International Normalized Ratio
Meta-analysis
Patients
Prothrombin
Prothrombin complex concentrate
Quality assessment
Retrospective Studies
Statistical analysis
Survival
Systematic review
Thromboembolism
Warfarin
Warfarin - adverse effects
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Summary:Patients requiring emergent warfarin reversal (EWR) have been prescribed three-factor prothrombin complex concentrate (PCC3) and four-factor prothrombin complex concentrate (PCC4) to reverse the anticoagulant effects of warfarin. There is no existing systematic review and meta-analysis of studies directly comparing PCC3 and PCC4. The primary objective of this systematic review and meta-analysis was to determine the effectiveness of achieving study defined target INR goal after PCC3 or PCC4 administration. Secondary objectives were to determine the difference in safety endpoints, thromboembolic events (TE), and survival during the patients' hospital stay. Random-effects meta-analysis models were used to estimate the odds ratios (OR), and heterogeneity associated with the outcomes. The Newcastle-Ottawa Scale was used to assess study quality, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Ten full-text manuscripts and five abstracts provided data for the primary and secondary outcomes. Patients requiring EWR had more than three times the odds of reversal to goal INR when they were given PCC4 compared to PCC3 (OR = 3.61, 95% CI: 1.97-6.60, p 
ISSN:1471-227X
1471-227X
DOI:10.1186/s12873-022-00568-x