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| http://dx.doi.org/10.1001/jama.2023.11671 | DOI Listing |
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Time to hemostatic agent administration increases mortality in veterans with factor Xa inhibitor-related intracranial hemorrhage.
Am J Emerg Med
August 2025
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare Edward Hines, Jr. VA Hospital, 5000 South 5th Ave, Hines, IL, USA. Electronic address:
Background: The two hemostatic agents utilized for reversal of life-threatening hemorrhage associated with Factor Xa (fXa) inhibition are andexanet alfa (AA) and four-factor prothrombin complex concentrate (4F-PCC). In May 2018, AA was approved with possible superior short-term hemostatic efficacy but has been linked with higher rates of thrombotic events. Considering these concerns, the absence of high-quality comparative studies, and the higher cost compared to other agents, four-factor prothrombin complex concentrate remained the more utilized agent.
View Article and Find Full Text PDFFixed-Dose Four-Factor Prothrombin Complex Concentrate for Reversal of Anticoagulation: Evaluation of Efficacy, Safety, and Cost Savings.
J Hematol
August 2025
Versiti Blood Center of Wisconsin, Greenfield, WI 53220, USA.
Background: Four-factor prothrombin complex concentrate (4F-PCC) is used for warfarin reversal and off-label management of bleeding in patients taking direct oral anticoagulants (DOACs). Dosing strategies that optimize hemostatic efficacy and cost, such as fixed dosing of 4F-PCC, are still under evaluation. The objective of this study was to retrospectively evaluate the efficacy, safety, and cost savings of fixed-dosing of 4F-PCC (1,500 IU for warfarin, 2,000 IU for DOACs).
View Article and Find Full Text PDFAndexanet alfa increases 30-day thrombotic events relative to four-factor prothrombin complex concentrate for factor Xa inhibitors-related intracerebral hemorrhage in veterans.
Am J Emerg Med
July 2025
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA.
Background And Objectives: Two hemostatic agents are commonly used to reverse factor Xa (fXa) inhibitor-related intracranial hemorrhage (ICH): andexanet alfa (AA) or 4-factor prothrombin complex concentrate (4F-PCC). We sought evaluate real-world data in Veterans diagnosed with fXa inhibitor-related ICH by comparing short-term mortality and thrombotic events in patients who received AA vs. 4F-PCC.
View Article and Find Full Text PDFEfficacy and Safety of Prothrombin complex Concentrate in Patients with Massive Intraoperative Bleeding During non-Cardiac Surgery: A Retrospective Cohort Study.
Clin Appl Thromb Hemost
July 2025
Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
PurposeThe efficacy and safety of four-factor prothrombin complex concentrate (4F-PCC) in managing bleeding during non-cardiac surgery are unclear. We investigated the associations of 4F-PCC with postoperative RBC transfusion and adverse events in non-cardiac surgery patients with massive intraoperative bleeding.MethodsThis retrospective cohort study consecutively included non-cardiac surgery patients with massive intraoperative bleeding at a tertiary hospital (2014-2020).
View Article and Find Full Text PDFFour-Factor Prothrombin Complex Concentrate vs Plasma in Patients on Vitamin K Antagonists With Gastrointestinal Bleeding or Needing a Gastrointestinal Procedure: A Retrospective Analysis of 2 Randomized Controlled Trials.
J Am Coll Emerg Physicians Open
June 2025
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Objectives: To examine the efficacy of 4-factor prothrombin complex concentrate (4F-PCC) compared with plasma in vitamin K antagonist (VKA)-treated patients with gastrointestinal (GI) bleeding or requiring a GI surgical/invasive procedure.
Methods: A retrospective analysis was conducted on a subset of data from 2 prospective phase 3b randomized controlled trials of 4F-PCC or plasma for VKA reversal. Data from patients receiving VKA who experienced acute major GI bleeding or needed a GI surgical/invasive procedure within 24 hours were included in the analysis.