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Treatment of adults with intracranial hemorrhage on apixaban or rivaroxaban with prothrombin complex concentrate products.
J Thromb Thrombolysis. 2020 Jun 04 [Online ahead of print]JT

Abstract

To analyze the efficacy and safety of activated prothrombin complex concentrates (aPCC) and four-factor prothrombin complex concentrates (4F-PCC) to prevent hematoma expansion in patients taking apixaban or rivaroxaban with intracranial hemorrhage (ICH). In this multicenter, retrospective study, sixty-seven ICH patients who received aPCC or 4F-PCC for known use of apixaban or rivaroxaban between February 2014 and September 2018 were included. The primary outcome was the percentage of patients who achieved excellent/good or poor hemostasis after administration of aPCC or 4F-PCC. Secondary outcomes included hospital mortality, thromboembolic events during admission, and transfusion requirements. Excellent/good hemostasis was achieved in 87% of aPCC patients, 89% of low-dose 4F-PCC [< 30 units per kilogram (kg)], and 89% of high-dose 4F-PCC (≥ 30 units per kg). There were no significant differences in excellent/good or poor hemostatic efficacy (p = 0.362). No differences were identified in transfusions 6 h prior (p = 0.087) or 12 h after (p = 0.178) the reversal agent. Mortality occurred in five patients, with no differences among the groups (p = 0.838). There were no inpatient thromboembolic events. Both aPCC and 4F-PCC appear safe and equally associated with hematoma stability in patients taking apixaban or rivaroxaban who present with ICH. Prospective studies are needed to identify a superior reversal agent when comparing andexanet alfa to hospital standard of care (4F-PCC or aPCC) and to further explore the optimal dosing strategy for patients with ICH associated with apixaban or rivaroxaban use.

Authors+Show Affiliations

Department of Pharmacy, University of California, Irvine Health, Orange, CA, USA.Department of Pharmacy, University of California San Diego Health, San Diego, CA, USA.Department of Pharmacy, University of California, Irvine Health, Orange, CA, USA.Department of Pharmacy, University of California San Diego Health, San Diego, CA, USA.Department of Pharmacy, University of California, Irvine Health, Orange, CA, USA.Department of Neurological Surgery and Neurology, University of California Davis Health, Sacramento, CA, USA.Department of Neurological Surgery and Neurology, University of California Davis Health, Sacramento, CA, USA.Department of Neurology, University of California, Irvine Health, Orange, CA, USA.Department of Neurology, University of California, Irvine Health, Orange, CA, USA.Department of Critical Care, University of California San Diego Health, San Diego, CA, USA.Department of Critical Care, University of California San Diego Health, San Diego, CA, USA.Department of Pharmacy, University of California San Diego Health, San Diego, CA, USA.Department of Pharmacy, University of California San Diego Health, San Diego, CA, USA.Department of Pharmacy, University of California Davis Health, Sacramento, CA, USA. kjschomer@ucdavis.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32500220

Citation

Castillo, Renee, et al. "Treatment of Adults With Intracranial Hemorrhage On Apixaban or Rivaroxaban With Prothrombin Complex Concentrate Products." Journal of Thrombosis and Thrombolysis, 2020.
Castillo R, Chan A, Atallah S, et al. Treatment of adults with intracranial hemorrhage on apixaban or rivaroxaban with prothrombin complex concentrate products. J Thromb Thrombolysis. 2020.
Castillo, R., Chan, A., Atallah, S., Derry, K., Baje, M., Zimmermann, L. L., Martin, R., Groysman, L., Stern-Nezer, S., Minokadeh, A., Nova, A., Huang, W., Cang, W., & Schomer, K. (2020). Treatment of adults with intracranial hemorrhage on apixaban or rivaroxaban with prothrombin complex concentrate products. Journal of Thrombosis and Thrombolysis. https://doi.org/10.1007/s11239-020-02154-z
Castillo R, et al. Treatment of Adults With Intracranial Hemorrhage On Apixaban or Rivaroxaban With Prothrombin Complex Concentrate Products. J Thromb Thrombolysis. 2020 Jun 4; PubMed PMID: 32500220.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of adults with intracranial hemorrhage on apixaban or rivaroxaban with prothrombin complex concentrate products. AU - Castillo,Renee, AU - Chan,Alissa, AU - Atallah,Steven, AU - Derry,Katrina, AU - Baje,Mark, AU - Zimmermann,Lara L, AU - Martin,Ryan, AU - Groysman,Leonid, AU - Stern-Nezer,Sara, AU - Minokadeh,Anush, AU - Nova,Alan, AU - Huang,WanTing, AU - Cang,William, AU - Schomer,Kendra, Y1 - 2020/06/04/ PY - 2020/6/6/pubmed PY - 2020/6/6/medline PY - 2020/6/6/entrez KW - Direct oral anticoagulants KW - Factor xa inhibitors KW - Hematomas KW - Hemostatics KW - Intracranial hemorrhages KW - Prothrombin complex concentrates JF - Journal of thrombosis and thrombolysis JO - J. Thromb. Thrombolysis N2 - To analyze the efficacy and safety of activated prothrombin complex concentrates (aPCC) and four-factor prothrombin complex concentrates (4F-PCC) to prevent hematoma expansion in patients taking apixaban or rivaroxaban with intracranial hemorrhage (ICH). In this multicenter, retrospective study, sixty-seven ICH patients who received aPCC or 4F-PCC for known use of apixaban or rivaroxaban between February 2014 and September 2018 were included. The primary outcome was the percentage of patients who achieved excellent/good or poor hemostasis after administration of aPCC or 4F-PCC. Secondary outcomes included hospital mortality, thromboembolic events during admission, and transfusion requirements. Excellent/good hemostasis was achieved in 87% of aPCC patients, 89% of low-dose 4F-PCC [< 30 units per kilogram (kg)], and 89% of high-dose 4F-PCC (≥ 30 units per kg). There were no significant differences in excellent/good or poor hemostatic efficacy (p = 0.362). No differences were identified in transfusions 6 h prior (p = 0.087) or 12 h after (p = 0.178) the reversal agent. Mortality occurred in five patients, with no differences among the groups (p = 0.838). There were no inpatient thromboembolic events. Both aPCC and 4F-PCC appear safe and equally associated with hematoma stability in patients taking apixaban or rivaroxaban who present with ICH. Prospective studies are needed to identify a superior reversal agent when comparing andexanet alfa to hospital standard of care (4F-PCC or aPCC) and to further explore the optimal dosing strategy for patients with ICH associated with apixaban or rivaroxaban use. SN - 1573-742X UR - https://www.unboundmedicine.com/medline/citation/32500220/Treatment_of_adults_with_intracranial_hemorrhage_on_apixaban_or_rivaroxaban_with_prothrombin_complex_concentrate_products L2 - https://doi.org/10.1007/s11239-020-02154-z DB - PRIME DP - Unbound Medicine ER -
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