Prothrombin Complex Concentrate Versus Standard Therapies for INR Reversal in Trauma Patients Receiving Warfarin

• Published in: The Annals of pharmacotherapy 2011-07, Vol.45 (7-8), p.869-875
• Main Authors: Chapman, Scott A, Irwin, Eric D, Beal, Alan L, Kulinski, Nichole M, Hutson, Katherine E, Thorson, Melissa AL
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anticoagulants - adverse effects; Anticoagulants - antagonists & inhibitors; Biological and medical sciences; Blood Coagulation Factors - therapeutic use; Critical Care; Female; Hemorrhage - etiology; Hemorrhage - mortality; Hemorrhage - therapy; Hemostatics - therapeutic use; Humans; Incidence; International Normalized Ratio; Length of Stay; Male; Medical Records; Medical sciences; Middle Aged; Minnesota - epidemiology; Pharmacology. Drug treatments; Registries; Retrospective Studies; Thromboembolism - epidemiology; Warfarin - adverse effects; Warfarin - antagonists & inhibitors; Wounds and Injuries - mortality; Wounds and Injuries - physiopathology; Wounds and Injuries - therapy
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1P605

Background: Prothrombin complex concentrate (PCC) is recommended as a therapy to be considered for the reversal of warfarin's effects. Few published data are available on the use of PCC for this indication in traumatically injured patients. Objective: To determine whether the addition of PCC to standard approaches to warfarin reversal more rapidly corrects the international normalized ratio (INR) in injured patients. Methods: A retrospective analysis was performed in trauma patients who were on warfarin preinjury from January 2007 to September 2009 at North Memorial Medical Center. Data were collected from medical records and the trauma registry. Patients were separated based on whether or not they received PCC. The groups were compared on the basis of demographics, units of fresh frozen plasma (FFP), vitamin K use, units of PCC, number of patients achieving an INR of 1.5 or less, time to an INR of 1.5 or less, mortality, intensive care unit (ICU) and hospital length of stay, and the incidence of thromboembolic events during hospitalization. Results: Thirty-one patients were included in the analysis; 13 patients who received a total mean (SD) dose of 2281 (1053) units (25.6 [12.2] units/kg) of PCC (Profilnine SD) were compared to 18 patients who did not receive PCC. There was no significant difference between groups in FFP units received or the number of patients who received vitamin K. Most patients in both groups achieved an INR of 1.5 or less (92% PCC vs 89% no PCC). However, the mean time to achieve an INR of 1.5 or less was 16:59 (20:53) hours in the PCC group versus 30:03 (23:10) hours in the no PCC group (p = 0.048). There were 3 deaths in the PCC group and no deaths in the no PCC group (p = 0.06). ICU and hospital length of stay and number of thromboembolic events did not differ significantly between the 2 groups. Conclusions: PCC, when added to FFP and vitamin K, resulted in a more rapid time to reversal of the INR.