Emergency reversal of oral anticoagulation through PPSB-SD: the fastest procedure in Belgium.
OBJECTIVE
To corroborate results obtained in The Netherlands with PPSB-SD, showing a safe acute reversal of anticoagulation within 15 minutes of administration.


METHODS
PPSB-SD is a concentrate prothrombin complex containing a relatively constant high level of vitamin K-dependant coagulation factors II, VII, IX and X. PPSB-SD was administered to 14 patients treated with oral anticoagulants, according the patient's weight, the initial and the target INR (< 2.0 for moderate haemorrhage and abdominal surgery, or < 1.5 for severe haemorrhage and cardio-vascular interventions). INR values were measured with the Coagucheck Pro (Roche Diagnostics) upon admission and at 15 minutes, 1, 3 and 5 hours after treatment, and confirmed by the hospitals' laboratory.


RESULTS
Within 15 minutes 11 patients out of 12 reached their INR target (data were missing for 2 patients). INR decreased rapidly, then remained stable for the next 5 hours. All patients had a favourable outcome: bleeding was stopped and no haemorrhage occurred during surgery. Only one adverse event was reported, but it was not related to the PPSB-SD treatment. No sign of disseminated intravascular coagulation was observed during this study. The administration of PPSB-SD along with vitamin K and dosed according to body weight and initial and target INR allowed for optimal reversal of anticoagulation, as no second infusion was necessary. The recommended dosing worked also very well for patients with high initial INR (9.2 to 22.8) who were brought down to normal values (0.9 to 1.1) within 15 minutes.


CONCLUSIONS
PPSB-SD can safely be used for the rapid reversal of anticoagulation as needed in emergency situations.
Lavenne-Pardonge
E
E
Clinique Notre Dame, Tournai, Belgium.
Itegwa
M Amuli
MA
Kalaai
M
M
Klinkenberg
G
G
Loncke
J L
JL
Pelgrims
K
K
Strengers
P F W
PF
D000005:Abdomen / Q000601:surgery; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001835:Body Weight; D003029:Coagulants / Q000627:therapeutic use*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000627:therapeutic use
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D003029:Coagulants; D014812:Vitamin K; C025667:prothrombin complex concentrates