title: Comparison of 3-Factor Prothrombin Complex Concentrate and Low-Dose Recombinant Factor VIIa for Warfarin Reversal.
abstract: BACKGROUND
  Prothrombin complex concentrate (PCC) and recombinant Factor VIIa (rFVIIa) have been used for emergent reversal of warfarin anticoagulation. Few clinical studies have compared these agents in warfarin reversal. We compared warfarin reversal in patients who received either 3 factor PCC (PCC3) or low-dose rFVIIa (LDrFVIIa) for reversal of warfarin anticoagulation.
  
  
  METHODS
  Data were collected from medical charts of patients who received at least one dose of PCC3 (20 units/kg) or LDrFVIIa (1000 or 1200 mcg) for emergent warfarin reversal from August 2007 to October 2011. The primary end-points were achievement of an INR 1.5 or less for efficacy and thromboembolic events for safety.
  
  
  RESULTS
  Seventy-four PCC3 and 32 LDrFVIIa patients were analyzed. Baseline demographics, reason for warfarin reversal, and initial INR were equivalent. There was no difference in the use of vitamin K or fresh frozen plasma. More LDrFVIIa patients achieved an INR of 1.5 or less (71.9% vs. 33.8%, p =0.001). The follow-up INR was lower after LDrFVIIa (1.25 vs. 1.75, p < 0.05) and the percent change in INR was larger after LDrFVIIa (54.1% vs. 38.8%, p = 0.002). There was no difference in the number of thromboembolic events (2 LDrFVIIa vs. 5 PCC3, p = 1.00), mortality, length of hospital stay, or cost.
  
  
  CONCLUSIONS
  Based on achieving a goal INR of 1.5 or less, LDrFVIIa was more likely than PCC3 to reverse warfarin anticoagulation. Thromboembolic events were equivalent in patients receiving PCC3 and LDrFVIIa.
authors.affiliation: Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, 7-115E Weaver Densford Hall 308 Harvard Street S.E, Minneapolis, MN 55455, USA ; Department of Pharmacy Services, North Memorial Medical Center, Minneapolis, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Chapman
authors.affiliation: Department of Trauma, North Memorial Medical Center, Robbinsdale, MN, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Irwin
authors.affiliation: University of Minnesota College of Pharmacy, 5-130 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
authors.forename: Nada M
authors.initials: NM
authors.lastname: Abou-Karam
authors.affiliation: Department of Pharmacy Services, North Memorial Medical Center, Minneapolis, USA ; Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, USA.
authors.forename: Nichole M
authors.initials: NM
authors.lastname: Rupnow
authors.affiliation: Department of Pharmacy Services, North Memorial Medical Center, Minneapolis, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Hutson
authors.affiliation: Department of Emergency Medicine, North Memorial Medical Center, Minneapolis, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Vespa
authors.affiliation: Department of Trauma, North Memorial Medical Center, Robbinsdale, MN, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Roach
keywords: Anticoagulation; Hemorrhage; Prothrombin complex concentrate; Recombinant factor VIIa; Trauma; Warfarin
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