• Rachel Van Dusen.
• Oregon Health and Sciences University, Astoria, OR 97103, United States. Electronic address: vandusen@ohsu.edu.
• Am. J. Surg. 2018 May 1; 215 (5): 780-781.

IntroductionLife-threatening bleeding is the most feared complication of warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin K dependent clotting factors is essential for hemostasis.MethodsA retrospective cohort study of warfarin-treated patients experiencing a life-threatening bleed treated with a warfarin reversal protocol comprised of 4F PCC (post-implementation group) and those who received the prior reversal protocol of 3F PCC and rFVIIa (pre-implementation group) was performed. Demographic and clinical information, anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded.Results195 patients were included in final analysis; 118 in the pre-implementation group, 77 in the post-implementation group. While baseline SOFA and GCS scores were similar between groups, the pre-implementation group had a longer ICU LOS and higher in-hospital mortality (p < .01, .01 respectively). The most common indication for anticoagulation reversal was intracranial hemorrhage in both groups. Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the pre-implementation group, 0.8 versus 1.3 (p < .01). Significantly more patients experienced thromboembolic complications (TEC) in the pre-implementation group than the post-implementation group, 27.9% versus 6.5% of patients (p < .01). The leading TEC in both groups was deep venous thrombosis. Differences in baseline characteristics (p ≤ .2) were entered into a Poisson log-linear regression model for association with TECs. Receipt of rFVIIa was the only characteristic significantly associated with TECs.DiscussionA 4F PCC warfarin reversal strategy is efficacious at reversing INR while providing significantly lower thromboembolic risk as compared to 3F PCC with rVIIa.Copyright © 2018 Elsevier Inc. All rights reserved.

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