Prothrombin Complex Concentrate in Direct Oral Anticoagulant Reversal: A Systematic Scoping Review

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-06-04 DOI:10.1016/j.jemermed.2025.05.013

Nazedah Ain Ibrahim PhD , Jiaa Yinn Tang BPharm , Hayati Alwani Yahaya MPharm , Sin Yee Tan MPharm , Szu Lynn Tay MPharm , Jivanraj Nagarajah MPharm

{"title":"Prothrombin Complex Concentrate in Direct Oral Anticoagulant Reversal: A Systematic Scoping Review","authors":"Nazedah Ain Ibrahim PhD , Jiaa Yinn Tang BPharm , Hayati Alwani Yahaya MPharm , Sin Yee Tan MPharm , Szu Lynn Tay MPharm , Jivanraj Nagarajah MPharm","doi":"10.1016/j.jemermed.2025.05.013","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants (DOAC) have emerged as an alternative to warfarin for treating venous thromboembolism and stroke prevention in atrial fibrillation. Reversal agents such as idarucizumab and andexanet alfa are not widely and readily available in Malaysia. In their absence, international guidelines recommend the administration of prothrombin complex concentrates (PCC) in life-threatening bleeding caused by DOAC.</div></div><div><h3>Objective</h3><div>To describe the reported PCC effectiveness and safety in reversing the anticoagulant effects of DOAC and provide better insight into its current practice in Malaysia.</div></div><div><h3>Methods</h3><div>This scoping review was conducted using the following databases: PubMed, Wiley Online Library, Sage Journals, and Google Scholar from 2016 until 2020. Clinical studies focusing on the utilization of PCC in the reversal of DOAC and fulfills the PRISMA extension for Scoping Reviews checklist were included. This review was registered with the National Medical Research Register, Malaysia (NMRR ID-22–01355-DC3).</div></div><div><h3>Results</h3><div>The systematic search retrieved 599 studies, 20 of which met the inclusion criteria. All studies described the use of PCC as a reversal agent for DOAC, with doses ranging between 25 and 50 u/kg. Hemostatic effectiveness was reported in 15 studies, 12 of which used the International Society on Thrombosis and Haemostasis (ISTH) criteria. All 20 studies assessed the safety of PCC in terms of overall risk of thrombotic events and mortality.</div></div><div><h3>Conclusions</h3><div>Further high-quality studies are essential to deepen understanding regarding PCC effectiveness and safety in achieving clinical hemostasis. However, this review provides the information regarding PCC as an option when DOAC-specific reversal agents are unavailable, or the type of DOAC is unknown.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 24-46"},"PeriodicalIF":1.3000,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0736467925002240","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Direct oral anticoagulants (DOAC) have emerged as an alternative to warfarin for treating venous thromboembolism and stroke prevention in atrial fibrillation. Reversal agents such as idarucizumab and andexanet alfa are not widely and readily available in Malaysia. In their absence, international guidelines recommend the administration of prothrombin complex concentrates (PCC) in life-threatening bleeding caused by DOAC.

Objective

To describe the reported PCC effectiveness and safety in reversing the anticoagulant effects of DOAC and provide better insight into its current practice in Malaysia.

Methods

This scoping review was conducted using the following databases: PubMed, Wiley Online Library, Sage Journals, and Google Scholar from 2016 until 2020. Clinical studies focusing on the utilization of PCC in the reversal of DOAC and fulfills the PRISMA extension for Scoping Reviews checklist were included. This review was registered with the National Medical Research Register, Malaysia (NMRR ID-22–01355-DC3).

Results

The systematic search retrieved 599 studies, 20 of which met the inclusion criteria. All studies described the use of PCC as a reversal agent for DOAC, with doses ranging between 25 and 50 u/kg. Hemostatic effectiveness was reported in 15 studies, 12 of which used the International Society on Thrombosis and Haemostasis (ISTH) criteria. All 20 studies assessed the safety of PCC in terms of overall risk of thrombotic events and mortality.

Conclusions

Further high-quality studies are essential to deepen understanding regarding PCC effectiveness and safety in achieving clinical hemostasis. However, this review provides the information regarding PCC as an option when DOAC-specific reversal agents are unavailable, or the type of DOAC is unknown.

查看原文本刊更多论文

凝血酶原复合浓缩物在直接口服抗凝逆转中的应用：一项系统的范围综述

直接口服抗凝剂（DOAC）已成为治疗心房颤动静脉血栓栓塞和预防中风的华法林的替代品。逆转药物如idarucizumab和anddexanet alfa在马来西亚没有广泛和容易获得。在这种情况下，国际指南建议在DOAC引起的危及生命的出血中使用凝血酶原复合物浓缩物（PCC）。目的描述已报道的PCC在逆转DOAC抗凝作用方面的有效性和安全性，并为马来西亚目前的实践提供更好的见解。方法本综述使用以下数据库：PubMed、Wiley Online Library、Sage Journals和谷歌Scholar，检索时间为2016 - 2020年。临床研究集中于PCC在DOAC逆转中的应用，并满足PRISMA扩展的范围审查清单。本综述已在马来西亚国家医学研究登记处注册（NMRR ID-22-01355-DC3）。结果系统检索到599篇文献，其中20篇符合纳入标准。所有研究都描述了PCC作为DOAC的逆转剂的使用，剂量范围在25至50 μ u/kg之间。15项研究报告了止血效果，其中12项采用了国际血栓和止血学会（ISTH）的标准。所有20项研究都从血栓事件和死亡率的总体风险方面评估了PCC的安全性。结论进一步开展高质量的研究，以加深对PCC在临床止血中的有效性和安全性的认识。然而，本综述提供了当DOAC特异性逆转药物不可用或DOAC类型未知时，PCC作为一种选择的信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine