Merav Barzilai1,2, Ilya Kirgner1,2, Arza Steimatzky3, Dalit Salzer Gotler4, Yulia Belnick5, Adi Shacham-Abulafia3,2, Irit Avivi1,2, Pia Raanani3,2, Vered Yahalom6, Sigal Nakav7, David Varon1, Ethan Yussim8, Gil N Bachar2,9, Galia Spectre10,11. 1. Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel. 4. Internal Medicine F, Sourasky Medical Center, Tel Aviv, Israel. 5. Internal Medicine D, Rabin Medical Center, Hasharon Hospital, Petah Tikva, Israel. 6. Transfusion and Apheresis Service, Rabin Medical Center, Petah Tikva, Israel. 7. Hemostasis Laboratory, Rabin Medical Center, Petah Tikva, Israel. 8. Department of Radiology, Sourasky Medical Center, Tel Aviv, Israel. 9. Department of Radiology, Rabin Medical Center, Petah Tikva, Israel. 10. Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel, galia.spectre@gmail.com. 11. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, galia.spectre@gmail.com.
Abstract
INTRODUCTION: Patients treated with direct Xa inhibitors may require urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is common; however, it is based on limited experience in healthy volunteers. OBJECTIVE: To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery and evaluate its efficacy and safety. METHODS: This was a retrospective study in 2 tertiary hospitals. Bleeding was evaluated based on surgical reports, hemoglobin drop, and the use of blood products or additional PCC during 48 h. Safety measures were thrombotic complications and 30-day mortality. RESULTS: Sixty-two patients aged 80.7 ± 9 years, treated with apixaban (39.63%) or rivaroxaban (23.37%), received PCC before an urgent surgery/procedure. Most underwent abdominal operation (61%), orthopedic surgery (13%), or transhepatic cholecystostomy insertion (10%). Bleeding during surgery was reported in 3 patients (5%), no patient required additional PCC, and 16 patients (26%) received packed cells (median: 1 unit, range: 1-5). The 30-day mortality and thrombosis rates were 21% (n = 13) and 3% (n = 2), respectively. The cause of death was related to the primary disease, most commonly sepsis. No patient died due to bleeding/thrombosis. CONCLUSIONS: Our results support the use of PCC to achieve hemostasis in patients treated with Xa inhibitors prior to an urgent surgery.
INTRODUCTION:Patients treated with direct Xa inhibitors may require urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is common; however, it is based on limited experience in healthy volunteers. OBJECTIVE: To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery and evaluate its efficacy and safety. METHODS: This was a retrospective study in 2 tertiary hospitals. Bleeding was evaluated based on surgical reports, hemoglobin drop, and the use of blood products or additional PCC during 48 h. Safety measures were thrombotic complications and 30-day mortality. RESULTS: Sixty-two patients aged 80.7 ± 9 years, treated with apixaban (39.63%) or rivaroxaban (23.37%), received PCC before an urgent surgery/procedure. Most underwent abdominal operation (61%), orthopedic surgery (13%), or transhepatic cholecystostomy insertion (10%). Bleeding during surgery was reported in 3 patients (5%), no patient required additional PCC, and 16 patients (26%) received packed cells (median: 1 unit, range: 1-5). The 30-day mortality and thrombosis rates were 21% (n = 13) and 3% (n = 2), respectively. The cause of death was related to the primary disease, most commonly sepsis. No patient died due to bleeding/thrombosis. CONCLUSIONS: Our results support the use of PCC to achieve hemostasis in patients treated with Xa inhibitors prior to an urgent surgery.