LAUSR

Learning Objectives: Four Factor Prothrombin Complex Concentrate (4F-PCC) is indicated for urgent reversal of vitamin K antagonist in patients with acute major bleeding or in need of urgent surgery/invasive procedure. Vitamin K is administered concurrently to maintain vitamin K-dependent clotting factor levels once the effects of 4F-PCC have diminished. Patients with history of thrombotic events 3 months prior to 4F-PCC administration were excluded in previous studies. The purpose of this study is to evaluate the appropriate use of 4F-PCC and to assess prevalence of thrombotic events following administration of 4F-PCC. Methods: This is a single-center, retrospective chart review of 225 patients who received 4F-PCC between January 1, 2016 and December 8, 2017. Electronic medical records were accessed to collect basic patient demographic information, past medical/medication history, 4F-PCC treatment outcome, dose and indication of 4FPCC, and concomitant vitamin K administration. Primary outcomes included evaluating 4F-PCC indications, dose, and thrombotic events following administration. Results: Two hundred and twenty five patients were enrolled in the study. One hundred and sixty-five patients (73.33%) received 4F-PCC for warfarin reversal; 21 patients (9.33%) for apixaban reversal; 18 patients (8%) for rivaroxaban reversal; and 1 patient (0.44%) for edoxaban reversal. One hundred and seventy-nine (179) patients (79.56%) were given 4F-PCC for an FDA-approved indication, such as acute major bleeding (56.44%) and emergent surgery (7.56%), with a total success in 167 patients (74.22%). Of the 21 patients (9.33%) with a history of thrombotic event 3 months prior to 4F-PCC administration, 2 patients experienced thrombotic events after administration. Of the 225 patients, 48 (21.3%) received 4F-PCC based on the providers’ clinical judgment, such as acute bleeding despite INR<2. The remaining 177 patients received 4F-PCC with an INR >2. With a variance of ± 5.0 units/kg, 143 (80.8%) of the 177 patients had an appropriate dose based on INR according to 4F-PCC prescribing information. However, only 120 patients (53%) were administered vitamin K concurrently as indicated with their 4F-PCC dose. Conclusions: 4F-PCC has been successfully utilized in majority of patients to provide immediate emergent reversal of vitamin k antagonist without death or complications. Further education is needed to ensure that 4F-PCC is administered for proper indication. In addition, vitamin K should be given concomitantly with 4F-PCC.