Four-Factor Prothrombin Complex Concentrate as a Strategy to Rapidly Reverse Anticoagulation in Patients Undergoing Cardiac Transplantation: Better Than the Conventional Approach?

T. Sam,¹ G. Gonzalez-Stawinski,² G. Saracino,³ A. Jamil,³ S. Hall,² K. Cox,¹ B. Lima.²

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%)	0.0232
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 May 9, 2025.

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