title: Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg-1: results of the RAPID study.
abstract: BACKGROUND
  Real-world studies of the emergency reversal of warfarin using 4-factor prothrombin complex concentrate (PCC) report unwarranted delays. The delay to receiving PCC was ≥ 8 h in 46·7% of patients with warfarin-associated bleeding (PWAB) treated with a variable PCC dosing protocol in our retrospective audit.
  
  
  OBJECTIVE
  To report the impact of a simplified PCC dosing protocol on the interval to reversal of anticoagulation.
  
  
  METHODS
  We developed a PCC dosing protocol standardising the initial PCC dose and simplifying dosing calculations. Study end points were the proportion of PWAB achieving international normalised ratio (INR) ≤1·5 and treated within 8 h of presentation, respectively.
  
  
  RESULTS
  Of 17, 15 (88·2%) PWABs achieved a post-treatment INR ≤ 1·5; 14 of 17 (82·4%) PWABs were reversed within 8 h. Median intervals between triage and PCC request and PCC request and start of infusion (administration interval) were 126 min (range 39-520) and 30 min (range 5-100), respectively. Compared with the retrospective cohort, RAPID is associated with an improved administration interval (mean 37·7 vs 76 min, P = 0·031) and the proportion of PWABs treated within 30 min (58·8 vs 6·7%, P = 0·009).
  
  
  CONCLUSIONS
  The RAPID protocol reduces unwarranted delays without compromising efficacy.
authors.affiliation: Department of Haematology, St James's University Hospital, Dublin, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Appleby
authors.affiliation: Department of Haematology, Limerick University Hospital, Limerick, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Groarke
authors.affiliation: Department of Haematology, St James's University Hospital, Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Crowley
authors.affiliation: Department of Haematology, Limerick University Hospital, Limerick, Ireland.
authors.forename: F A
authors.initials: FA
authors.lastname: Wahab
authors.affiliation: Department of Haematology, St James's University Hospital, Dublin, Ireland.
authors.forename: A M
authors.initials: AM
authors.lastname: McCann
authors.affiliation: Department of Haematology, St James's University Hospital, Dublin, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Egan
authors.affiliation: Department of Haematology, St James's University Hospital, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Gough
authors.affiliation: Department of Emergency Medicine, St. James's University Hospital, Dublin, Ireland.
authors.forename: G
authors.initials: G
authors.lastname: McMahon
authors.affiliation: Department of Haematology, St James's University Hospital, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Donghaile
authors.affiliation: Department of Haematology, Limerick University Hospital, Limerick, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Keeffe
authors.affiliation: Department of Haematology, St James's University Hospital, Dublin, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: O'Connell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001779:Blood Coagulation Factors / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D014859:Warfarin
keywords: administration delay; prothrombin complex concentrate; warfarin reversal