Daniel Dybdahl1, Grant Walliser2, M Chance Spalding3, Michelle Pershing4, Michelle Kincaid5. 1. Department of Pharmacy, OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215, United States of America. Electronic address: Daniel.Dybdahl@ohiohealth.com. 2. Department of Pharmacy, OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215, United States of America. Electronic address: Grant.Walliser@ohiohealth.com. 3. Department of Trauma, OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215, United States of America. Electronic address: Chance.Spalding@ohiohealth.com. 4. Department of Research, OhioHealth Research & Innovation Institute, 340 East Town Street, Suite 7-100, Columbus, OH 43215, United States of America. Electronic address: Michelle.Pershing@ohiohealth.com. 5. Department of Trauma, OhioHealth Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215, United States of America. Electronic address: Michelle.Kincaid@ohiohealth.com.
Abstract
OBJECTIVE: The objective of this study was to determine the effectiveness and safety of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitors in patients with traumatic intracranial hemorrhage (ICH). METHODS: This was a retrospective cohort study of patients taking factor Xa inhibitors with traumatic ICH between March 1, 2015 and August 31, 2017 at two trauma centers. The primary outcome was in-hospital mortality in patients who received 4F-PCC (4F-PCC group) compared to those who did not (no reversal group). Secondary outcomes included functional recovery, hospital and intensive care unit (ICU) length of stay (LOS), and thromboembolic complications. RESULTS: There were 62 patients included in the study. Injury Severity Score (ISS) was significantly higher in the 4F-PCC group (17.6 vs. 12.1, p = 0.019). The 4F-PCC group had a significantly higher mortality (22.9% vs. 3.7%, p = 0.034) and longer ICU LOS (2.5 vs. 1.4 days, p = 0.0024). The no reversal group had a significantly higher incidence of ischemic stroke/transient ischemic attack (TIA) (0% vs. 14.8%, p = 0.019). After controlling for ISS, there was no significant difference in mortality (p = 0.20), ICU LOS (p = 0.64), or ischemic stroke/TIA (p = 0.94). There was no difference in hospital LOS, discharge disposition, final Activity Measure for Post Acute Care daily activity score, VTE, or MI. CONCLUSION: Patients with a higher ISS received 4F-PCC preferentially, which led to an apparent mortality benefit the no reversal group. After adjusting for baseline differences between groups, there was no difference in mortality, functional recovery, hospital and ICU LOS, or thromboembolic complications.
OBJECTIVE: The objective of this study was to determine the effectiveness and safety of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitors in patients with traumatic intracranial hemorrhage (ICH). METHODS: This was a retrospective cohort study of patients taking factor Xa inhibitors with traumatic ICH between March 1, 2015 and August 31, 2017 at two trauma centers. The primary outcome was in-hospital mortality in patients who received 4F-PCC (4F-PCC group) compared to those who did not (no reversal group). Secondary outcomes included functional recovery, hospital and intensive care unit (ICU) length of stay (LOS), and thromboembolic complications. RESULTS: There were 62 patients included in the study. Injury Severity Score (ISS) was significantly higher in the 4F-PCC group (17.6 vs. 12.1, p = 0.019). The 4F-PCC group had a significantly higher mortality (22.9% vs. 3.7%, p = 0.034) and longer ICU LOS (2.5 vs. 1.4 days, p = 0.0024). The no reversal group had a significantly higher incidence of ischemic stroke/transient ischemic attack (TIA) (0% vs. 14.8%, p = 0.019). After controlling for ISS, there was no significant difference in mortality (p = 0.20), ICU LOS (p = 0.64), or ischemic stroke/TIA (p = 0.94). There was no difference in hospital LOS, discharge disposition, final Activity Measure for Post Acute Care daily activity score, VTE, or MI. CONCLUSION:Patients with a higher ISS received 4F-PCC preferentially, which led to an apparent mortality benefit the no reversal group. After adjusting for baseline differences between groups, there was no difference in mortality, functional recovery, hospital and ICU LOS, or thromboembolic complications.
Authors: Victoria M Stevens; Toby C Trujillo; Tyree H Kiser; Robert MacLaren; Paul M Reynolds; Scott W Mueller Journal: Clin Appl Thromb Hemost Date: 2021 Jan-Dec Impact factor: 2.389
Authors: Olivia S Costa; William L Baker; Yuani Roman-Morillo; Kelly McNeil-Posey; Belinda Lovelace; C Michael White; Craig I Coleman Journal: BMJ Open Date: 2020-11-05 Impact factor: 2.692