title: Prevention of treatment-related fluid overload reduces estimated effective cost of prothrombin complex concentrate in patients requiring rapid vitamin K antagonist reversal.
abstract: BACKGROUND
  Fresh frozen plasma (FFP) is a frequently used human blood product to reverse the effects of vitamin K antagonists. While FFP is relatively economical, its large fluid volume can lead to hospitalization complications, therefore increasing the overall cost of use.
  
  
  METHODS
  A recently published article by Sarode et al., in Circulation, described the rate of volume overload associated with FFP use for reversal of vitamin K antagonists. This condition, described as transfusion-associated circulatory overload, has a defined rate of intensive care admission, which also has a well-reported average cost. The additional monetary value of intensive care unit admission and caring for fluid overload is then compared to the cost of another product, four-factor prothrombin complex concentrates, which does not, as per the Sarode paper, result in fluid overload.
  
  
  RESULTS
  The increased costs attributed to FFP-associated fluid overload for vitamin K antagonist reversal partly defrays the increased upfront cost of four-factor prothrombin complex concentrates.
  
  
  CONCLUSIONS
  FFP is commonly used to acutely reverse the effects of vitamin K antagonists. However, its use requires significant time for infusion, may lead to fluid overload, and is not fully effective in compete anticoagulation reversal. One alternative therapy for anticoagulant reversal is use of prothrombin complex concentrates, which are rapidly infused, are not associated with fluid overload, and are effective in complete reversal of coagulation measurements. This should be considered for patients with acute bleeding emergencies.
authors.affiliation: a 1 Global Health Economics Unit of the Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA.|b 2 Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.|c 3 Center for Science and Society, Trinity College, University of Oxford, Oxford, UK.|d 4 European Centre for International Political Economy, Brussels, Belgium.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Jones
authors.affiliation: b 2 Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Ducis
authors.affiliation: a 1 Global Health Economics Unit of the Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA.|e 5 Compara Biomedical, Orlando, FL, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petrozzino
authors.affiliation: a 1 Global Health Economics Unit of the Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA.|b 2 Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Clark
authors.affiliation: b 2 Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Fung
authors.affiliation: h 8 CSL Behring, In.c, Marburg, Germany.|i 9 Therakos In.c, 10 N. High St, West Chester, PA 19380, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Peters
authors.affiliation: a 1 Global Health Economics Unit of the Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA.|f 6 Biomedical Informatics Unit of the Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA.
authors.forename: Indra Neil
authors.initials: IN
authors.lastname: Sarkar
authors.affiliation: b 2 Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Emilia
authors.initials: E
authors.lastname: Krol
authors.affiliation: a 1 Global Health Economics Unit of the Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA.
authors.forename: Brina
authors.initials: B
authors.lastname: Pochal
authors.affiliation: g 7 University of Vermont, College of Medicine, Burlington, VT, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Boutrus
authors.affiliation: b 2 Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Weimersheimer
authors.affiliation: b 2 Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Kalev
authors.initials: K
authors.lastname: Freeman
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000008:administration & dosage* / Q000191:economics; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010949:Plasma; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates
keywords: FP24; anticoagulant; bleeding; cost–effectiveness; fresh frozen plasma; plasma; transfusion-associated circulatory overload; vitamin K; warfarin reversal