Arachchillage, Deepa R. J.;
Alavian, Sharon;
Griffin, Jessica;
Gurung, Kamala;
Szydlo, Richard;
Karawitage, Nilanthi;
Laffan, Mike
Efficacy and safety of prothrombin complex concentrate in patients treated with rivaroxaban or apixaban compared to warfarin presenting with major bleeding
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Medientyp:
E-Artikel
Titel:
Efficacy and safety of prothrombin complex concentrate in patients treated with rivaroxaban or apixaban compared to warfarin presenting with major bleeding
Beteiligte:
Arachchillage, Deepa R. J.;
Alavian, Sharon;
Griffin, Jessica;
Gurung, Kamala;
Szydlo, Richard;
Karawitage, Nilanthi;
Laffan, Mike
Erschienen:
Wiley, 2019
Erschienen in:
British Journal of Haematology, 184 (2019) 5, Seite 808-816
Beschreibung:
<jats:title>Summary</jats:title><jats:p>This retrospective study investigated the efficacy and safety of prothrombin complex concentrates (<jats:styled-content style="fixed-case">PCC</jats:styled-content>s) for management of major bleeding events (<jats:styled-content style="fixed-case">MBE</jats:styled-content>) in 344 patients receiving the anticoagulants rivaroxaban, apixaban or warfarin during the period January 2016 to April 2018. Median (range) <jats:styled-content style="fixed-case">PCC</jats:styled-content> dose was 2000 units (1000–4500). Intracranial haemorrhage (<jats:styled-content style="fixed-case">ICH</jats:styled-content>) was the most common indication (137/344, 39·8%) for <jats:styled-content style="fixed-case">PCC</jats:styled-content> use followed by gastrointestinal bleeding (93/344, 27%). <jats:styled-content style="fixed-case">ICH</jats:styled-content> patients more frequently received rivaroxaban (62·5%) or apixaban (52·5%) compared to warfarin (34·5%), <jats:italic>P </jats:italic>= 0·002; and visceral bleeding patients received warfarin more frequently (24·2%) than rivaroxaban (5%) or apixaban (10%), <jats:italic>P</jats:italic> = 0·003. Median rivaroxaban and apixaban levels were 230 ng/ml (47–759) and 159 ng/ml (45–255). Median International Normalised Ratio pre‐ and post‐<jats:styled-content style="fixed-case">PCC</jats:styled-content> in patients on warfarin were 3·4 (1·9–15·4) and 1·2 (1·0–1·9). Blood products use was the same between groups. Thirty‐day mortality and re‐bleeding rates in patients with <jats:styled-content style="fixed-case">ICH</jats:styled-content> were 35% (<jats:italic>P</jats:italic> = 0·50) and 18% (<jats:italic>P</jats:italic> = 0·90) with no differences between the groups. Thrombosis occurred in 4·1% patients within 30 days with no difference between groups. Two of 91 (2·2%) patients with <jats:styled-content style="fixed-case">ICH</jats:styled-content> only (both on warfarin) had ischaemic strokes within 30 days post‐<jats:styled-content style="fixed-case">PCC</jats:styled-content>. In conclusion, there was no difference in the safety (thrombosis) or efficacy (30‐day mortality, re‐bleeding) in use of <jats:styled-content style="fixed-case">PCC</jats:styled-content> for <jats:styled-content style="fixed-case">MBE</jats:styled-content> in patients on warfarin, rivaroxaban or apixaban.</jats:p>