title: Real world usage of PCC to "rapidly" correct warfarin induced coagulopathy.
abstract: BACKGROUND
  Life threatening bleeding and emergency procedures in patients on vitamin K antagonists are indications for urgent reversal with prothrombin complex concentrate and vitamin K. Rapid reversal in these situations is emphasized in the literature and guidelines, but only very limited information is available on its real life use, especially on the timing of treatment in relation to presentation.
  
  
  METHODS
  We retrospectively audited emergency warfarin reversal in 131 consecutive patients. We studied the indication, use of vitamin K, time between presentation and administration of vitamin K and PCC, effectiveness in INR reduction and clinical outcome.
  
  
  RESULTS
  The median PCC dose was 26.8 IU/kg. The median INR was reduced from 3.1 to 1.2. Vitamin K (5 mg) was given in 91.6% of evaluable patients. We found significant delays in administration of PCC and vitamin K. The median time between presentation and administration of vitamin K/PCC was 3.6 and 5.2 hours respectively. The times in intracranial haemorrhage were 2.7 and 3.0 hours and in emergency procedures 17.4 and 15.9 hours respectively. Mortality related to bleeding was 7.6% overall but in patients with intracranial haemorrhage 22.8%. The thrombotic rate within 7 days of reversal was 1.5%.
  
  
  CONCLUSIONS
  The local protocol for reversal with PCC and vitamin K was adhered to well but the delay in pre-procedural patients, suggests that intravenous vitamin K alone may be sufficient in many cases and PCC administration can be avoided by better planning. Intracranial haemorrhage in warfarinised patients carries a high mortality. Treatment delays should be avoided by making PCC stocks available within emergency departments, simple dosing structures independent of INR and administering PCC without waiting for INR and CT scan results in those with strong suspicion of intracranial haemorrhage and clear trauma. Future reports and studies should always include the time from presentation to PCC treatment.
authors.affiliation: Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Toth
authors.affiliation: Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom.
authors.forename: Joost Jair
authors.initials: JJ
authors.lastname: van Veen
authors.affiliation: Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Robinson
authors.affiliation: Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom.
authors.forename: Rhona Murray
authors.initials: RM
authors.lastname: Maclean
authors.affiliation: Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom.
authors.forename: Kingsley Kevin
authors.initials: KK
authors.lastname: Hampton
authors.affiliation: Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Laidlaw
authors.affiliation: Sheffield Haemophilia and Thrombosis Centre, Sheffield, United Kingdom Department of Cardiovascular Science, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Makris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D003029:Coagulants / Q000008:administration & dosage / Q000009:adverse effects*; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D014812:Vitamin K / Q000008:administration & dosage*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D003029:Coagulants; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin