PB0985 - Clinical experience in factor Xa inhibitors´ reversal with prothrombin complex concentrate in emergency settings

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Juan Manuel Cerezo Martín, MD

Resident
Sistema Cantabro de Salud
santander, Cantabria, Spain

Co-Author(s)

GM

Gala A. Mendez

Doctor
University Hospital Marqués de Valdecilla
Santander, Cantabria, Spain
IR

Iñigo Romon

Doctor
University Hospital Marqués de Valdecilla
Santander, Cantabria, Spain
BG

Belen González-Mesones

Doctor
University Hospital Marqués de Valdecilla
Santander, Cantabria, Spain
Mg

M.luisa gonzalez

Doctor
University Hospital Marqués de Valdecilla
Santander, Cantabria, Spain
MP

M. Rocío Pérez

Doctor
University Hospital Marqués de Valdecilla
Santander, Cantabria, Spain
SF

Sara Fernández-Luis

Doctor
University Hospital Marqués de Valdecilla
Santander, Cantabria, Spain
EO

Enrique Ocio

Chief Doctor
University Hospital Marqués de Valdecilla
Santander, Cantabria, Spain

Background: Studies evaluating clinical outcomes of direct oral anticoagulants (DOACs) related emergencies are scarce and heterogeneous and the optimal 4F-PCC dose for reversal is still not well defined.

Aims: To describe the characteristics, management and outcomes of patients anticoagulated with an oral FXa inhibitor (FXa-I) who were treated with 4F-PCC. The secondary aim is to evaluate adverse-related effects.

Methods: This is a retrospective and observational review of cases treated with 4F-PCC between 2016 and 2020 for the reversal of FXa-I because of major bleeding or an urgent surgery. Management of the DOAC-related emergency was at the discretion of the treating physician.
The effectiveness of the reversal was measured with the need for red blood cell (RBC) or fresh frozen plasma (FFP) transfusion within two weeks after reversal. We documented the occurrence of thrombotic events within four weeks of PCC administration and other related adverse-effects.

Results: Forthy patients were included, all of them were anticoagulated because of atrial fibrillation. Twenty-six (65%) patients were treated with apixaban and 17 (42.5%) patients were reversed because of an urgent surgery. The most common site of bleeding was intracranial (15%) (Table 1).
Median dose of 4F-PCC was 1000 UI. Only in 20 patients was the weight available in the medical history, being the median 4F-PCC dose 14,3 UI/kg. Sixteen (40%) patients required a RBC or FFP transfusion. Patients reversed with a 4F-PCC dose of 20U/Kg or greater needed less transfusions than patients reversed with inferior doses, OR 0.05 (CI95% 0.04-0.597) (Table 2). No thromboembolic event was diagnosed. However, thromboprophylaxis was early administered in 25 patients (62.5%). A serious anaphylactic reaction was recorded in a patient.

Conclusion(s): The use of 4F-PCC at low or intermediate doses and with posterior thromboprophylaxis may be a good treatment option in patients requiring DOAC reversal when an specific reversal agent is not available.