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INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma
Restoration of the international normalized ratio (INR) to values <1.5 is commonly targeted to achieve hemostasis in patients with major bleeding or undergoing urgent surgery who are treated using vitamin K antagonists (VKAs). However, the relationship between corrected INR and vitamin K–dependen...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The American Society of Hematology
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196991/ https://www.ncbi.nlm.nih.gov/pubmed/36574241 http://dx.doi.org/10.1182/bloodadvances.2022009015 |
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author | Hood, Christopher Goldstein, Joshua N. Milling, Truman J. Refaai, Majed A. Bajcic, Paolo Goldstein, Brahm Sarode, Ravi |
author_facet | Hood, Christopher Goldstein, Joshua N. Milling, Truman J. Refaai, Majed A. Bajcic, Paolo Goldstein, Brahm Sarode, Ravi |
author_sort | Hood, Christopher |
collection | PubMed |
description | Restoration of the international normalized ratio (INR) to values <1.5 is commonly targeted to achieve hemostasis in patients with major bleeding or undergoing urgent surgery who are treated using vitamin K antagonists (VKAs). However, the relationship between corrected INR and vitamin K–dependent factor (VKDF) levels for hemostasis is uncertain. We aim to examine the impact of 4-factor prothrombin complex concentrate (4F-PCC) or plasma on INR correction and VKDF restoration and evaluate the relationship between INR values and VKDF levels in patients with acute major bleeding or patients requiring an urgent surgical procedure. Adult patients treated with VKA with an elevated INR (≥2.0 within 3 hours before study treatment) who received 4F-PCC or plasma after major bleeding or before an urgent surgery or invasive procedure were included in this retrospective analysis of data from 2 prospective phase 3b randomized controlled trials. Of the 370 patients included in this analysis, 185 received 4F-PCC, and 185 received plasma. In the 4F-PCC group, 159 of 185 (85.9%) had an INR ≤1.5 at 30 minutes after the end of infusion compared with only 72 of 184 (39.1%) in the plasma group. After 4F-PCC treatment, all VKDF levels exceeded 50% activity regardless of the postinfusion INR value. However, after plasma administration, mean activity levels for factors II and X were <50% at all time points assessed within 3 hours after starting the infusion, regardless of the postinfusion INR value. This retrospective analysis demonstrated that treatment with 4F-PCC among patients treated with VKA rapidly restores VKDFs to hemostatic levels irrespective of the postinfusion INR value, whereas treatment with plasma does not. |
format | Online Article Text |
id | pubmed-10196991 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | The American Society of Hematology |
record_format | MEDLINE/PubMed |
spelling | pubmed-101969912023-05-20 INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma Hood, Christopher Goldstein, Joshua N. Milling, Truman J. Refaai, Majed A. Bajcic, Paolo Goldstein, Brahm Sarode, Ravi Blood Adv Thrombosis and Hemostasis Restoration of the international normalized ratio (INR) to values <1.5 is commonly targeted to achieve hemostasis in patients with major bleeding or undergoing urgent surgery who are treated using vitamin K antagonists (VKAs). However, the relationship between corrected INR and vitamin K–dependent factor (VKDF) levels for hemostasis is uncertain. We aim to examine the impact of 4-factor prothrombin complex concentrate (4F-PCC) or plasma on INR correction and VKDF restoration and evaluate the relationship between INR values and VKDF levels in patients with acute major bleeding or patients requiring an urgent surgical procedure. Adult patients treated with VKA with an elevated INR (≥2.0 within 3 hours before study treatment) who received 4F-PCC or plasma after major bleeding or before an urgent surgery or invasive procedure were included in this retrospective analysis of data from 2 prospective phase 3b randomized controlled trials. Of the 370 patients included in this analysis, 185 received 4F-PCC, and 185 received plasma. In the 4F-PCC group, 159 of 185 (85.9%) had an INR ≤1.5 at 30 minutes after the end of infusion compared with only 72 of 184 (39.1%) in the plasma group. After 4F-PCC treatment, all VKDF levels exceeded 50% activity regardless of the postinfusion INR value. However, after plasma administration, mean activity levels for factors II and X were <50% at all time points assessed within 3 hours after starting the infusion, regardless of the postinfusion INR value. This retrospective analysis demonstrated that treatment with 4F-PCC among patients treated with VKA rapidly restores VKDFs to hemostatic levels irrespective of the postinfusion INR value, whereas treatment with plasma does not. The American Society of Hematology 2022-12-28 /pmc/articles/PMC10196991/ /pubmed/36574241 http://dx.doi.org/10.1182/bloodadvances.2022009015 Text en © 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Thrombosis and Hemostasis Hood, Christopher Goldstein, Joshua N. Milling, Truman J. Refaai, Majed A. Bajcic, Paolo Goldstein, Brahm Sarode, Ravi INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma |
title | INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma |
title_full | INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma |
title_fullStr | INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma |
title_full_unstemmed | INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma |
title_short | INR and vitamin K–dependent factor levels after vitamin K antagonist reversal with 4F-PCC or plasma |
title_sort | inr and vitamin k–dependent factor levels after vitamin k antagonist reversal with 4f-pcc or plasma |
topic | Thrombosis and Hemostasis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196991/ https://www.ncbi.nlm.nih.gov/pubmed/36574241 http://dx.doi.org/10.1182/bloodadvances.2022009015 |
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