Recommended Citation
Pecoraro C, McInerney A, Shah A. Comparing Different Dosing Strategies of Prothrombin Complex Concentrate in Factor Xa Inhibitor-Related Intracerebral Hemorrhage. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
Four-factor prothrombin complex concentrate (4PCC) is used off-label for factor Xa inhibitor (FXaI)-associated life-threatening hemorrhages. The American Heart Association/American Stroke Association Intracerebral Hemorrhage (ICH) 2022 Guidelines consider 4PCC use in FXaI-associated ICH but do not specify a dose. Several studies have demonstrated similar efficacy and cost savings when dosed at 25 units/kg compared to 50 units/kg, regardless of bleed location.
Purpose:
Determine whether there is a difference in hemostatic efficacy between 25 units/kg versus 50 units/kg of 4PCC for FXaI reversal in ICH.
Methods:
This was a single-center review of adult patients who received 4PCC in the Emergency Department for reversal of FXaI-related ICH from February 2020 to January 10, 2025. The primary outcome evaluated the hemostatic effectiveness within 24 hours of 4PCC administration, determined by improvement or worsening of hematoma size based on radiologist impression of computed tomography imaging. Additional outcomes included incidence of thromboembolic events within 30 days, in-hospital mortality, hospital length of stay, and cost per dose administered.
Results:
A total of 120 patients who received 4PCC for FXaI-associated ICH were included in the analysis. Hemostasis was evaluable in 113 patients with 24-hour post-4PCC imaging available. There was no difference in hemostatic efficacy between groups (92% low dose vs. 86% high dose, p=0.50). Thromboembolic events 30 days post-4PCC occurred in 5.4% versus 7.2% (p=0.64). There was a higher incidence of in-hospital mortality among the high-dose group compared to low-dose (24.1% vs. 8.1%, p=0.04), however patients in the high-dose group were noted to have more severe injuries upon presentation.
Conclusion:
The findings of this study add to existing literature supporting a 25 units/kg dose as an effective alternative to 50 units/kg 4PCC dosing and provides cost savings for the reversal of FXaI in ICH.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
wf_yes
Document Type
Poster
Comparing Different Dosing Strategies of Prothrombin Complex Concentrate in Factor Xa Inhibitor-Related Intracerebral Hemorrhage
Background/Significance:
Four-factor prothrombin complex concentrate (4PCC) is used off-label for factor Xa inhibitor (FXaI)-associated life-threatening hemorrhages. The American Heart Association/American Stroke Association Intracerebral Hemorrhage (ICH) 2022 Guidelines consider 4PCC use in FXaI-associated ICH but do not specify a dose. Several studies have demonstrated similar efficacy and cost savings when dosed at 25 units/kg compared to 50 units/kg, regardless of bleed location.
Purpose:
Determine whether there is a difference in hemostatic efficacy between 25 units/kg versus 50 units/kg of 4PCC for FXaI reversal in ICH.
Methods:
This was a single-center review of adult patients who received 4PCC in the Emergency Department for reversal of FXaI-related ICH from February 2020 to January 10, 2025. The primary outcome evaluated the hemostatic effectiveness within 24 hours of 4PCC administration, determined by improvement or worsening of hematoma size based on radiologist impression of computed tomography imaging. Additional outcomes included incidence of thromboembolic events within 30 days, in-hospital mortality, hospital length of stay, and cost per dose administered.
Results:
A total of 120 patients who received 4PCC for FXaI-associated ICH were included in the analysis. Hemostasis was evaluable in 113 patients with 24-hour post-4PCC imaging available. There was no difference in hemostatic efficacy between groups (92% low dose vs. 86% high dose, p=0.50). Thromboembolic events 30 days post-4PCC occurred in 5.4% versus 7.2% (p=0.64). There was a higher incidence of in-hospital mortality among the high-dose group compared to low-dose (24.1% vs. 8.1%, p=0.04), however patients in the high-dose group were noted to have more severe injuries upon presentation.
Conclusion:
The findings of this study add to existing literature supporting a 25 units/kg dose as an effective alternative to 50 units/kg 4PCC dosing and provides cost savings for the reversal of FXaI in ICH.
Affiliations
Advocate Lutheran General Hospital