Reduced Time to Procedure for Gastrointestinal Bleeding After Warfarin Reversal With Four-Factor Complex Concentrate as Compared to Plasma.

Hannah Spector, Hannah L McRae, Tanzy Love, Kalynn Northam, Khaled Refaai, Marian A Rollins-Raval, Majed A Refaai
{"title":"Reduced Time to Procedure for Gastrointestinal Bleeding After Warfarin Reversal With Four-Factor Complex Concentrate as Compared to Plasma.","authors":"Hannah Spector,&nbsp;Hannah L McRae,&nbsp;Tanzy Love,&nbsp;Kalynn Northam,&nbsp;Khaled Refaai,&nbsp;Marian A Rollins-Raval,&nbsp;Majed A Refaai","doi":"10.14740/jocmr4856","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Bleeding is a serious adverse effect of vitamin K antagonists (VKAs). Anticoagulation reversal is required in some acute cases. This is usually accomplished by plasma transfusion or four-factor prothrombin complex concentrate (4F-PCC). The aim of this study was to gain insight into the clinical course of patients with gastrointestinal (GI) bleeding who require VKA reversal.</p><p><strong>Methods: </strong>Medical records were collected from two centers from patients who presented to the emergency department (ED) for GI bleeding and received 4F-PCC or plasma for VKA reversal between January 2015 and December 2020. ED, hospital, intensive care unit (ICU) length of stay (LOS) as well as time from admission to GI procedure were determined.</p><p><strong>Results: </strong>4F-PCC patients (n = 49) as compared to plasma (n = 63) patients were found to have a greater number of comorbidities (average of 4.2 vs. 2.7 comorbidities/patient) and more ICU admissions (47% vs. 21%). Time to GI procedure was significantly decreased in the 4F-PCC group (median (interquartile range (IQR)) 19.47 (9.23 - 30.25) vs. 27.88 (21.38 - 45.00) h; P = 0.01). When adjusting for comorbidities, differences in time to GI procedures were also significant in favor of 4F-PCC regardless of any comorbidities (P = 0.014), in atrial fibrillation (P = 0.045) and in hypertension (P = 0.02). The 4F-PCC patients had shorter LOS in the ED and ICU.</p><p><strong>Conclusions: </strong>Our study demonstrated that compared to plasma, 4F-PCC was utilized in more acutely ill patients with higher rates of comorbidities and ICU admission. Nevertheless, the patients who received 4F-PCC had faster access to GI procedure and shorter ED and ICU LOS.</p>","PeriodicalId":15431,"journal":{"name":"Journal of Clinical Medicine Research","volume":"15 1","pages":"51-57"},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/af/jocmr-15-051.PMC9881491.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Medicine Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14740/jocmr4856","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Bleeding is a serious adverse effect of vitamin K antagonists (VKAs). Anticoagulation reversal is required in some acute cases. This is usually accomplished by plasma transfusion or four-factor prothrombin complex concentrate (4F-PCC). The aim of this study was to gain insight into the clinical course of patients with gastrointestinal (GI) bleeding who require VKA reversal.

Methods: Medical records were collected from two centers from patients who presented to the emergency department (ED) for GI bleeding and received 4F-PCC or plasma for VKA reversal between January 2015 and December 2020. ED, hospital, intensive care unit (ICU) length of stay (LOS) as well as time from admission to GI procedure were determined.

Results: 4F-PCC patients (n = 49) as compared to plasma (n = 63) patients were found to have a greater number of comorbidities (average of 4.2 vs. 2.7 comorbidities/patient) and more ICU admissions (47% vs. 21%). Time to GI procedure was significantly decreased in the 4F-PCC group (median (interquartile range (IQR)) 19.47 (9.23 - 30.25) vs. 27.88 (21.38 - 45.00) h; P = 0.01). When adjusting for comorbidities, differences in time to GI procedures were also significant in favor of 4F-PCC regardless of any comorbidities (P = 0.014), in atrial fibrillation (P = 0.045) and in hypertension (P = 0.02). The 4F-PCC patients had shorter LOS in the ED and ICU.

Conclusions: Our study demonstrated that compared to plasma, 4F-PCC was utilized in more acutely ill patients with higher rates of comorbidities and ICU admission. Nevertheless, the patients who received 4F-PCC had faster access to GI procedure and shorter ED and ICU LOS.

Abstract Image

Abstract Image

Abstract Image

与血浆相比,四因子复合浓缩华法林逆转后胃肠道出血的手术时间缩短。
背景:出血是维生素K拮抗剂(VKAs)的严重不良反应。一些急性病例需要抗凝逆转。这通常通过血浆输注或四因子凝血酶原复合物浓缩物(4F-PCC)来完成。本研究的目的是深入了解需要VKA逆转的胃肠道(GI)出血患者的临床病程。方法:从两个中心收集2015年1月至2020年12月期间就诊于急诊科(ED)并接受4F-PCC或血浆治疗VKA逆转的患者的医疗记录。确定ED、医院、重症监护病房(ICU)的住院时间(LOS)以及从入院到GI手术的时间。结果:4F-PCC患者(n = 49)比血浆患者(n = 63)有更多的合并症(平均4.2比2.7合并症/患者)和更多的ICU入院(47%比21%)。4F-PCC组到GI手术的时间显著缩短(中位数(四分位数间距(IQR)) 19.47(9.23 - 30.25)比27.88 (21.38 - 45.00)h;P = 0.01)。当调整合并症时,无论合并症如何(P = 0.014),在心房颤动(P = 0.045)和高血压(P = 0.02)中,4F-PCC在GI手术的时间上也有显著差异。4F-PCC患者在急诊科和ICU的LOS较短。结论:我们的研究表明,与血浆相比,4F-PCC用于更多急症患者,其合并症和ICU住院率更高。然而,接受4F-PCC的患者获得GI手术的时间更快,ED和ICU的LOS时间更短。
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
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信