title: Outcomes Associated With Prothrombin Complex Concentrate for International Normalized Ratio Reversal in Patients on Oral Anticoagulants With Acute Bleeding.
abstract: BACKGROUND
  Management of bleeding in patients on oral anticoagulants (OACs) is crucial in optimizing outcomes. No large studies examine 3-factor prothrombin complex concentrate (PCC) for OAC reversal.
  
  
  OBJECTIVE
  To assess outcomes after administration of 3-factor PCC for reversal of international normalized ratio (INR).
  
  
  METHODS
  We conducted an institutional review board-approved retrospective cohort study in all patients admitted to our level II trauma center over a 5-year period from 2007 to 2012 who received PCC for INR reversal and bleeding management. The primary outcome was assessment of efficacy as measured by achievement of INR < 1.5. Secondary objectives were to evaluate: factors associated with achievement of target INR, cessation of bleeding, mortality, outcome differences with or without fresh frozen plasma (FFP) or protocol utilization, safety, and cost.
  
  
  RESULTS
  A total of 403 patients were evaluated. Target INR was achieved in 88.8% of patients and was influenced by baseline INR. Associated factors were younger age (P = 0.02), utilization of the institution's protocol (P < 0.01), and concomitant administration of vitamin K (P < 0.01). Concomitant FFP did not affect achievement. Bleeding cessation occurred in 333 (82.6%) patients, and 68 (16.9%) patients died. Patients who achieved target INR were more likely to have bleeding cessation (P < 0.01). The odds of survival for those who reached target INR was 3.8 times greater (P < 0.01). The incidence of thromboembolism was 3.7%.
  
  
  CONCLUSIONS
  Three-factor PCC administration with IV vitamin K was effective for INR reversal and bleeding cessation and should continue to be a mainstay of therapy pending head-to-head outcome and cost comparisons with 4-factor products.
authors.affiliation: Mission Health System Department of Pharmacy, Asheville, NC, USA Ryan.Tilton@msj.org.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tilton
authors.affiliation: Mission Health System Department of Pharmacy, Asheville, NC, USA University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
authors.forename: Elizabeth Landrum
authors.initials: EL
authors.lastname: Michalets
authors.affiliation: University of Virginia Health System Department of Pharmacy, Charlottesville, VA, USA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Delk
authors.affiliation: Mission Hospital Research Institute, Asheville, NC, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Sutherland
authors.affiliation: Mission Health System and Carolina Mountain Emergency Medicine, Asheville, NC, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Ramming
keywords: anticoagulation; clinical pharmacology; emergency medicine; trauma; warfarin