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Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT)

This study evaluated practice patterns and factors influencing treatment decisions regarding urgent or emergent reversal of oral anticoagulants (OACs). A 30-question survey was electronically distributed to anticoagulation members of the Anticoagulation Forum. Questions were designed to capture prac...

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Autores principales: Deng, Huiwen, Nutescu, Edith A., DiDomenico, Robert J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259145/
https://www.ncbi.nlm.nih.gov/pubmed/37272034
http://dx.doi.org/10.1177/10760296231176808
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author Deng, Huiwen
Nutescu, Edith A.
DiDomenico, Robert J.
author_facet Deng, Huiwen
Nutescu, Edith A.
DiDomenico, Robert J.
author_sort Deng, Huiwen
collection PubMed
description This study evaluated practice patterns and factors influencing treatment decisions regarding urgent or emergent reversal of oral anticoagulants (OACs). A 30-question survey was electronically distributed to anticoagulation members of the Anticoagulation Forum. Questions were designed to capture practice trends in the reversal of warfarin, factor Xa inhibitors, and factor IIa inhibitors. Continuous and categorical data were analyzed to generate descriptive statistics. Open-ended questions were summarized by thematic categories. 173 responses were collected most from US-based pharmacists with direct patient care responsibilities. The majority of the respondents’ institutions (90.2%) utilized a guideline or protocol for OACs reversal. Vitamin K (91.3%), activated charcoal (80.4%), and fresh frozen plasma (72.8%) were the most common reversal agents on formulary without restrictions. Most institutions (87.0%) reported having 4-factor prothrombin complex concentrate (4F-PCC) and idarucizumab on formulary, but most commonly (52.2%) with restrictions. Andexanet alfa was only reported on formulary at 35.9% of institutions. In contrast to current guideline recommendations, vitamin K (98.8%) was preferred over 4F-PCC and 4F-PCC (71.6%) was preferred over andexanet alfa as first-line agents used to reverse warfarin and factor Xa inhibitors, respectively. Weight-based dosing strategies for 4F-PCC were commonly utilized for different reversals (41.2%-59.4%). Cost, efficacy, and safety of 4F-PCC were identified as top facilitators and barriers for 4F-PCC adoption in practice. Our findings revealed that guideline recommendations for reversal of warfarin and factor Xa and IIa inhibitors are not followed by a majority of institutions. Studies are needed to investigate strategies to overcome barriers for implementing and following guideline recommendations.
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spelling pubmed-102591452023-06-13 Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT) Deng, Huiwen Nutescu, Edith A. DiDomenico, Robert J. Clin Appl Thromb Hemost Original Manuscript This study evaluated practice patterns and factors influencing treatment decisions regarding urgent or emergent reversal of oral anticoagulants (OACs). A 30-question survey was electronically distributed to anticoagulation members of the Anticoagulation Forum. Questions were designed to capture practice trends in the reversal of warfarin, factor Xa inhibitors, and factor IIa inhibitors. Continuous and categorical data were analyzed to generate descriptive statistics. Open-ended questions were summarized by thematic categories. 173 responses were collected most from US-based pharmacists with direct patient care responsibilities. The majority of the respondents’ institutions (90.2%) utilized a guideline or protocol for OACs reversal. Vitamin K (91.3%), activated charcoal (80.4%), and fresh frozen plasma (72.8%) were the most common reversal agents on formulary without restrictions. Most institutions (87.0%) reported having 4-factor prothrombin complex concentrate (4F-PCC) and idarucizumab on formulary, but most commonly (52.2%) with restrictions. Andexanet alfa was only reported on formulary at 35.9% of institutions. In contrast to current guideline recommendations, vitamin K (98.8%) was preferred over 4F-PCC and 4F-PCC (71.6%) was preferred over andexanet alfa as first-line agents used to reverse warfarin and factor Xa inhibitors, respectively. Weight-based dosing strategies for 4F-PCC were commonly utilized for different reversals (41.2%-59.4%). Cost, efficacy, and safety of 4F-PCC were identified as top facilitators and barriers for 4F-PCC adoption in practice. Our findings revealed that guideline recommendations for reversal of warfarin and factor Xa and IIa inhibitors are not followed by a majority of institutions. Studies are needed to investigate strategies to overcome barriers for implementing and following guideline recommendations. SAGE Publications 2023-06-04 /pmc/articles/PMC10259145/ /pubmed/37272034 http://dx.doi.org/10.1177/10760296231176808 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Manuscript
Deng, Huiwen
Nutescu, Edith A.
DiDomenico, Robert J.
Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT)
title Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT)
title_full Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT)
title_fullStr Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT)
title_full_unstemmed Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT)
title_short Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT)
title_sort reversal of oral anticoagulants: a survey of contemporary practice trends (react)
topic Original Manuscript
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259145/
https://www.ncbi.nlm.nih.gov/pubmed/37272034
http://dx.doi.org/10.1177/10760296231176808
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