Effect of 4-prothrombin complex concentrate on mortality in patients presenting to the emergency department with warfarin-induced bleeding

Abstract

DOI: 10.4328/ACAM.20700 Received: 2021-05-11 Accepted: 2021-06-29 Published Online: 2021-07-04 Printed: 2021-07-01 Ann Clin Anal Med 2021;12(7):784-787 Corresponding Author: Haydar Karahan, Department of Emergency Medicine, Ministry of Health Mardin Province Nusaybin State Hospital, Mardin, Turkey. E-mail: [email protected] P: +90 532 135 87 36 Corresponding Author ORCID ID: https://orcid.org/0000-0002-5114-5969 Abstract Aim: Today, it has been observed that the increase in the use of vitamin K antagonists (VKA) causes various complications, from acute bleeding to death. Fresh frozen plasma and 4-prothrombin complex concentrate (4-PCC) are still used in the treatment of these patients. In our study, we aimed to investigate the effect of 4-PCC use on early mortality in patients presenting with bleeding due to VKA. Material and Methods: Our study was conducted in a district state hospital with a retrospective and single-center design. It enrolled a total of 89 patients with a history of vitamin K antagonist drug use; patients with a history of trauma-induced hemorrhage or hematological disease were excluded. Results: Out of 89 patients with a mean age of 71.00±10.79 years, 51.7% were male and 51.7% had a major hemorrhage and 48.3% had minor hemorrhage. Twenty-seven percent of the patients died despite treatment. The mean post-admission INR level was 9.48±5.8. Post-treatment and 24-hour INR levels were significantly lower in both patient groups treated with 4-PCC and FFP. It was determined that the administration of vitamin K did not lead to any significant difference in both patient groups treated with FFP and 4-PCC. Additionally, the treatment lasted 4 times longer, and the mortality rate was 4 times higher among patients treated with FFP than those treated with 4-PCC. Discussion: We detected that the use of 4-PCC to reverse the anticoagulant effect will provide more rapid treatment, less volume loading, and lower mortality among patients using VKAs.