title: Emergency reversal of anticoagulation: from theory to real use of prothrombin complex concentrates. A retrospective Italian experience.
abstract: BACKGROUND
  Prothrombin Complex Concentrates (PCC) are administered to normalise blood coagulation in patients receiving oral anticoagulant therapy (OAT). Rapid reversal of OAT is essential in case of major bleeding, internal haemorrhage or surgery.The primary end-point was to evaluate whether PCC in our hospital were being used in compliance with international and national guidelines for the reversal of OAT on an emergency basis. The secondary end-point was to evaluate the efficacy and safety of PCC.
  
  
  METHODS
  All patients receiving OAT who required rapid reversal anticoagulation because they had to undergo emergency surgery or urgent invasive techniques following an overdose of oral anticoagulants were eligible for this retrospective observational study.
  
  
  RESULTS
  Forty-seven patients receiving OAT who needed rapid reverse of anticoagulation were enrolled in our study. The patients were divided in two groups: (i) group A (n=23), patients needed haemostatic treatment before neurosurgery after a head injury and (ii) group B (n=24), patients with critical haemorrhage because of an overdose of oral anticoagulants. The International Normalised Ratio (INR) was checked before and after infusion of the PCC. The mean INR in group A was 2.7 before and 1.43 after infusion of the PCC; in group B the mean INR of 6.58, before and 1.92 after drug infusion. The use of vitamin K, fresh-frozen plasma and red blood cells was also considered. During our study 22 patients died, but no adverse effects following PCC administration were recorded.
  
  
  CONCLUSIONS
  In our study three-factor-PCC was found to be effective and safe in rapidly reversing the effects of OAT, although it was not always administered in accordance with international or national guidelines. The dose, time of administration and monitoring often differed from those recommended. In the light of these findings, we advocate the use of single standard protocol to guide the correct use of PCC in each hospital ward.
authors: Center for Hemorrhagic and Thrombotic Diseases, University Hospital, Udine, Italy.
authors: Giovanni
authors: G
authors: Barillari
authors: Samantha
authors: S
authors: Pasca
authors: Alfredo
authors: A
authors: Barillari
authors: Vincenzo
authors: V
authors: De Angelis
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000008:administration & dosage* / Q000009:adverse effects; D006259:Craniocerebral Trauma / Q000097:blood / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D019983:Guideline Adherence; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods; D008297:Male; D019635:Neurosurgical Procedures; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates