title: Case series of four-factor prothrombin complex concentrate for warfarin reversal before heart transplantation.
abstract: OBJECTIVE
  Describe the experience of using 4-factor prothrombin complex concentrate (PCC4) in patients with a ventricular assist device (VAD) scheduled for imminent heart transplant who are receiving warfarin.
  
  
  METHODS
  We are reporting a clinical case series describing 4 patients with VADs treated with PCC4 for anticoagulation reversal before heart transplantation. Data collection was performed via retrospective medical chart review from March 27, 2014, to July 20, 2014.
  
  
  RESULTS
  Average time to anticoagulation reversal was 2.45 hours and average volume of PCC4 injection was 86 mL. No patient experienced a thromboembolic event or a decrease in hemoglobin indicative of a bleeding event. Average volume of packed red blood cells, platelets, and fresh frozen plasma (FFP) patients received was 2,325 mL. Patient 1 experienced a hypersensitivity reaction and patient 2 experienced thrombocytopenia postoperatively. The average acquisition cost was $3,824 and the average retail price was $7,143 per complete dose.
  
  
  CONCLUSIONS
  PCC4 contributed to efficient reduction of International Normalized Ratio (INR) before surgery. PCC4 requires less volume than FFP for similar INR reductions. PCC4 was a beneficial agent in our patients with VADs; however, a cost-benefit analysis is needed to evaluate the future utility of PCC4.
authors.affiliation: Virginia Commonwealth University School of Pharmacy, Sentara Norfolk General, Norfolk, Virginia. Electronic address: nuckleskb@vcu.edu.
authors.forename: K B
authors.initials: KB
authors.lastname: Nuckles
authors.affiliation: Pharmacy Services, Sentara Norfolk General, Norfolk, Virginia.
authors.forename: J H
authors.initials: JH
authors.lastname: Pratt
authors.affiliation: Pharmacy Services, Sentara Norfolk General, Norfolk, Virginia.
authors.forename: C M
authors.initials: CM
authors.lastname: Cameron
authors.affiliation: Pharmacy Services, Sentara Norfolk General, Norfolk, Virginia.
authors.forename: A I
authors.initials: AI
authors.lastname: Ingemi
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006470:Hemorrhage; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011300:Preoperative Care; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D014859:Warfarin