Four-Factor Prothrombin Complex Concentrate as a Strategy to Rapidly Reverse Anticoagulation in Patients Undergoing Cardiac Transplantation: Better Than the Conventional Approach?
1Department of Pharmacy, Baylor University Medical Center, Dallas, TX
2Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, TX
3Baylor Research Institute, Baylor University Medical Center, Dallas, TX.
Meeting: 2016 American Transplant Congress
Abstract number: B164
Keywords: Anticoagulation, Heart transplant patients
Session Information
Session Name: Poster Session B: Hearts and VADs in Depth - The Force Awakens
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Purpose
The purpose of this analysis is to compare outcomes of administering four-factor prothrombin complex concentrate (4F-PCC, Kcentra™) versus standard of care for anticoagulation reversal in patients undergoing cardiac transplantation.
Methods
This is a single-center, retrospective cohort of all subjects admitted for cardiac transplantation between the dates of August 2013 and March 2015 at Baylor University Medical Center in Dallas, TX. Final analysis only included subjects requiring anticoagulation reversal prior to procedure. Baseline characteristics were similar in each arm. Data of interest includes immediate prior history of anticoagulation, international normalized ratio (INR) prior to reversal, documentation of reversal (timing and choice of medication), and use of blood product in peri- and post-operative period. Control treatment consisted of preoperative fresh frozen plasma (FFP) and phytonadione (vitamin K).
Results
The 4F-PCC cohort required significantly less FFP compared to controls, but had equivalent survival, and rates of reoperations for bleeding. The 4F-PCC arm trended towards requiring more PRBC however statistical significance was not reached. Rate of moderate/severe PGD was statistically higher for subjects receiving 4F-PCC.
| Outcome | Control N=89 |
4F-PCC N=19 |
p Value |
| 30 Day In Hospital Mortality | 1 (1.1%) | 1 (5.3%) | 0.3223 |
| Reoperation for Bleeding | 15 (16.9%) | 3 (15.8%) | 1.0000 |
| None/Mild PGD* | 83 (93.3%) | 14 (73.7%) | 0.0232 |
| Moderate/Severe PGD* | 6 (6.7%) | 5 (26.3%) | |
| Mean Product Use (SD) | |||
| FFP | 2.15 (3.31) | 0.05 (0.23) | 0.002 |
| Cryoprecipitate | 0.88 (4.14) | 1.05 (4.59) | 0.631 |
| Platelets | 0.61 (2.12) | 0.95 (3.21) | 0.628 |
| PRBC** | 2.39 (3.76) | 2.68 (8.44) | 0.076 |
| *Primary Graft Dysfunction **Packed Red Blood Cells | |||
Conclusions
4F-PCC is an alternate strategy for timely anticoagulation reversal in patients undergoing cardiac transplantation. Relative to the administration of plasma and vitamin K, this novel approach does not appear to significantly reduce bleeding events or transfusion of red blood cells in this patient cohort.
CITATION INFORMATION: Sam T, Gonzalez-Stawinski G, Saracino G, Jamil A, Hall S, Cox K, Lima B. Four-Factor Prothrombin Complex Concentrate as a Strategy to Rapidly Reverse Anticoagulation in Patients Undergoing Cardiac Transplantation: Better Than the Conventional Approach? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Sam T, Gonzalez-Stawinski G, Saracino G, Jamil A, Hall S, Cox K, Lima B. Four-Factor Prothrombin Complex Concentrate as a Strategy to Rapidly Reverse Anticoagulation in Patients Undergoing Cardiac Transplantation: Better Than the Conventional Approach? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/four-factor-prothrombin-complex-concentrate-as-a-strategy-to-rapidly-reverse-anticoagulation-in-patients-undergoing-cardiac-transplantation-better-than-the-conventional-approach/. Accessed November 25, 2024.« Back to 2016 American Transplant Congress