title: Low-dose 3-factor prothrombin complex concentrate for warfarin reversal prior to heart transplant.
abstract: BACKGROUND
  Anticoagulation with warfarin is common in patients presenting for heart transplant. Prior to surgery, anticoagulation reversal is necessary to avoid significant intraoperative and perioperative bleeding complications. Commonly, warfarin reversal is achieved with vitamin K and fresh frozen plasma (FFP); however, these therapies have significant limitations. An alternative to FFP for reversal exists with prothrombin complex concentrate (PCC). A warfarin reversal protocol prior to heart transplant was implemented using low-dose PCC at our institution.
  
  
  OBJECTIVE
  To assess blood product use, effectiveness, and safety post-low-dose PCC administration in patients needing warfarin reversal prior to heart transplant compared with historical controls.
  
  
  METHODS
  This was a single-center, retrospective cohort study. The PCC cohort included patients undergoing heart transplant presenting with an international normalized ratio ≥1.5 on warfarin therapy and who received at least 1 dose of PCC. Blood product use was measured from postoperative day 0 to 2.
  
  
  RESULTS
  The PCC and historical control cohorts included 16 and 50 patients, respectively. There was a significant reduction in the use of FFP (4 vs 8 units, P = 0.0239) in the PCC cohort compared with the historical control cohort. No differences were identified in the use of other blood products as well as other secondary efficacy or safety end points.
  
  
  CONCLUSIONS
  Use of PCC, per the reversal protocol, prior to heart transplant reduced FFP use and showed a non-statistically significant trend toward reductions in the use of other blood products in the intraoperative and perioperative setting, with no difference identified in thrombotic or embolic complications compared with historical controls.
authors.affiliation: Chicago State University College of Pharmacy, Chicago, IL, USA Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kantorovich
authors.affiliation: University Hospitals Ahuja Medical Center, Beachwood, OH, USA.
authors.forename: Jodie M
authors.initials: JM
authors.lastname: Fink
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Militello
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Wanek
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Soltesz
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA moazamn@ccf.org.
authors.forename: Nader
authors.initials: N
authors.lastname: Moazami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014859:Warfarin / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D014859:Warfarin
keywords: anticoagulation; cardiology; surgery; transplantation; warfarin