Abstract Number: PB0088
Meeting: ISTH 2021 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: The recommended reversal agent for vitamin K antagonists (VKA) related bleeding is four-factor prothrombin complex concentrate (4F-PCC). Despite over 40 years of clinical experience with 4F-PCC, literature remains ambiguous about the optimal dosing strategy, with current guidelines advising fixed doses or variable doses based on INR and bodyweight.
Aims: To investigate the proportion of hospitals using a fixed dosing strategy for 4F-PCC in treatment of VKA related bleeding in the Netherlands.
Methods: A survey was conducted among hospital pharmacists. The hospital pharmacist responsible for local anticoagulation policy of each hospital in the Netherlands was first identified by phone and then e-mailed access to an online survey. The main questions regarded the 4F-PCC dosing strategies in VKA-related extracranial and intracranial bleeding.
Results: Of the 106 identified hospitals, 74 responded (69.8% response rate). A total of 39 hospitals (52.7%) reported the use of a fixed dose in VKA-related extracranial or intracranial bleeding emergencies, 30 hospitals used only the variable dosing strategy (40.5%). Most fixed strategies were implemented for extracranial bleeds (51.4%), either 1000 IU (84.2%) or 500 IU (15.8%). For intracranial bleeds 23 hospitals (31.1%) used a fixed dose, mostly 1000 IU (65.2%), however larger doses up to 2000 IU were seen. The implementation of fixed dosing in academic hospitals seemed to be not as widespread as in non-academic hospitals (20% versus 55.1%). Furthermore smaller hospitals had implemented the fixed dose more frequently, possibly for pragmatic reasons and costs. 95.9% of hospitals reported to have a local treatment protocol and 83.8% had 4F-PCC stored in the emergency department, minimizing door-to-needle time.
Conclusions: A fixed dose was implemented in 52.7% of hospitals in the Netherlands. The uptake of fixed dosing is considerable, given the scarcity of data, especially in intracranial bleeding. Future research should provide a decisive answer on the positioning of dosing strategies.
To cite this abstract in AMA style:
Abdoellakhan R, Meijer K, Roelofsen E, van de Craats V, Khorsand N. Adaptation of fixed prothrombin complex concentrate dosing for vitamin K antagonist-related bleeding in the Netherlands [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/adaptation-of-fixed-prothrombin-complex-concentrate-dosing-for-vitamin-k-antagonist-related-bleeding-in-the-netherlands/. Accessed March 21, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/adaptation-of-fixed-prothrombin-complex-concentrate-dosing-for-vitamin-k-antagonist-related-bleeding-in-the-netherlands/