• Am J Emerg Med · Oct 2019

    Four-factor prothrombin complex concentrate for the reversal of factor Xa inhibitors for traumatic intracranial hemorrhage.

    • Daniel Dybdahl, Grant Walliser, Chance Spalding M M Department of Trauma, OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215, United States of America. Electronic address: Chanc, Michelle Pershing, and Michelle Kincaid.
    • Department of Pharmacy, OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215, United States of America. Electronic address: Daniel.Dybdahl@ohiohealth.com.
    • Am J Emerg Med. 2019 Oct 1; 37 (10): 1907-1911.

    ObjectiveThe objective of this study was to determine the effectiveness and safety of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitors in patients with traumatic intracranial hemorrhage (ICH).MethodsThis was a retrospective cohort study of patients taking factor Xa inhibitors with traumatic ICH between March 1, 2015 and August 31, 2017 at two trauma centers. The primary outcome was in-hospital mortality in patients who received 4F-PCC (4F-PCC group) compared to those who did not (no reversal group). Secondary outcomes included functional recovery, hospital and intensive care unit (ICU) length of stay (LOS), and thromboembolic complications.ResultsThere were 62 patients included in the study. Injury Severity Score (ISS) was significantly higher in the 4F-PCC group (17.6 vs. 12.1, p = 0.019). The 4F-PCC group had a significantly higher mortality (22.9% vs. 3.7%, p = 0.034) and longer ICU LOS (2.5 vs. 1.4 days, p = 0.0024). The no reversal group had a significantly higher incidence of ischemic stroke/transient ischemic attack (TIA) (0% vs. 14.8%, p = 0.019). After controlling for ISS, there was no significant difference in mortality (p = 0.20), ICU LOS (p = 0.64), or ischemic stroke/TIA (p = 0.94). There was no difference in hospital LOS, discharge disposition, final Activity Measure for Post Acute Care daily activity score, VTE, or MI.ConclusionPatients with a higher ISS received 4F-PCC preferentially, which led to an apparent mortality benefit the no reversal group. After adjusting for baseline differences between groups, there was no difference in mortality, functional recovery, hospital and ICU LOS, or thromboembolic complications.Copyright © 2019 Elsevier Inc. All rights reserved.

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