title: Retrospective study of rFVIIa, 4-factor PCC, and a rFVIIa and 3-factor PCC combination in improving bleeding outcomes in the warfarin and non-warfarin patient.
abstract: In case of severe bleeding, the physician must rapidly and effectively halt bleeding without the risk of thromboembolic complications. Despite widespread use, no study has directly compared recombinant activated factor VII (rFVIIa), the rFVIIa and 3-factor prothrombin complex concentrate (PCC) combination ("combination"), and 4-factor PCC on their effectiveness in improving patient outcomes. This study examined the medical records of 299 patients, 65.2% on warfarin prior to admission, who received these hemostatic agents and were admitted to an ICU or through the emergency department at Oregon Health & Science University. Mortality, length of stay, change in international normalized ratio (INR), plasma use, and number of thromboembolic complications were used to assess effectiveness. In patients receiving warfarin, the combination group had the greatest decrease in INR as well as lowest overall INR, but experienced a higher number of clotting complications, while the rFVIIa group used the most plasma. Non-warfarin patients in the combination group had the shortest length of stay among survivors, but the rFVIIa group had the lowest mortality. Based on this data, it may be prudent to further study the use of rFVIIa in treating extreme bleeding in the non-warfarin patient, while this study supports other data that 4-factor PCC may be the most prudent for the warfarin patient. Am. J. Hematol. 91:705-708, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Westminster College, Salt Lake City, Utah.|Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
authors.forename: Emma
authors.initials: E
authors.lastname: DeLoughery
authors.affiliation: Westminster College, Salt Lake City, Utah.
authors.forename: Brian
authors.initials: B
authors.lastname: Avery
authors.affiliation: Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.|Division of Laboratory Medicine, Department of Pathology, Oregon Health & Science University, Portland, Oregon.|Division of Hematology/Medical Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: DeLoughery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D019934:International Normalized Ratio; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013923:Thromboembolism; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D014859:Warfarin; C103587:recombinant FVIIa; D015942:Factor VIIa