Abstract Number: PB1112
Meeting: ISTH 2020 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Management of Bleeding and Trauma
Background: Direct oral anticoagulants (DOACs) including direct thrombin inhibitors (DTIs) and factor Xa (fXa) inhibitors are extensively used. Idarucizumab is available in our centre for reversal of DTIs while three-factor prothrombin complex concentrate (3F-PCC) remains the choice of reversal for major bleeding associated with fXa inhibitors.
Aims: Our study aims to analyze the risk of thrombosis, bleeding and mortality for patients on DOACs with 3F-PCC reversal for major bleeding or emergency operations.
Methods: This was a retrospective study conducted at Tuen Mun Hospital, a tertiary trauma centre in Hong Kong. Patients aged ≥ 18 years old on DOACs who received reversal by 3F-PCC for major bleeding or emergency operation from January 2014 to October 2019 were recruited. Outcome measures included risk of 7-day thrombosis, 7-day haemorrhage and 30-day morality after 3F-PCC reversal.
Results: Fifty-two patients (male to female ratio: 1:1) were recruited. Rivaroxaban (40.4%) was the most commonly-used DOACs, followed by Apxiaban (38.4%), Dabigatran (19.2%) and Edoxaban (2%). The median age of our cohort was 79 years old (51-101 years old). Atrial fibrillation (AF, 88.5%) was the main indication for anticoagulation. The median CHA2DS2-VASc score for AF patients was 5 (0-9).
Forty-two patients (80.8%) received 3F-PCC as reversal for major bleeding and 10 patients (19.2%) for emergency operation (Table 1). Intracranial haemorrhage (ICH) accounted for 54.7% of major bleeding and the median Glasgow Coma Scale upon reversal was 13 (3-15) for ICH patients.
The overall risk of 7-day thrombosis and 7-day haemorrhage after reversal were 3.8% and 19.2% respectively (Table 2). All post-reversal thrombosis occurred in major bleeding group while 20% of post-reversal haemorrhage occurred in emergency operation group. The overall 30-day mortality was 32.7%. Death due to thrombosis or bleeding in major bleeding group accounted for 62.5% of cases.
Type of major bleeding | Type of emergency operation | ||||
Nature of bleeding | Number of patients | Percentage | Nature of operation | Number of patients | Percentage |
Intracranial haemorrhage | 23/42 | 54.7% | Abdominal surgery | 5/10 | 50% |
Gastrointestinal bleeding | 8/42 | 19% | Vascular surgery | 1/10 | 10% |
Intra-abdominal bleeding | 3/42 | 7.1% | Neurosurgical surgery | 1/10 | 10% |
Haemoptysis | 2/42 | 4.8% | Cardiothoracic surgery or procedure | 1/10 | 10% |
Others | 6/42 | 14.4% | Others | 2/10 | 20% |
[Table 1. Details of major bleeding and emergency operation]
DOAC | 7-day thrombotic risk after reversal by 3F-PCC | 7-day haemorrhagic risk after reversal by 3F-PCC |
Overall | 3.8% | 19.2% |
Dabigatran | 0% | 20% |
Rivaroxaban | 4.8% | 19% |
Apixaban | 5% | 20% |
Edoxaban | 0% | 0% |
[Table 2. Post-reversal thrombotic and haemorrhagic risk and mortality]
Conclusions: Our study signifies the thrombotic and haemorrhagic risk after reversal of DOACs by 3F-PCC.
To cite this abstract in AMA style:
Kong SY, Yip SF, Ha CY. Reversal of Direct Oral Anticoagulants with Three-Factor Prothrombin Complex Concentrate: Real World Experience from a Tertiary Centre in Hong Kong [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/reversal-of-direct-oral-anticoagulants-with-three-factor-prothrombin-complex-concentrate-real-world-experience-from-a-tertiary-centre-in-hong-kong/. Accessed April 17, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/reversal-of-direct-oral-anticoagulants-with-three-factor-prothrombin-complex-concentrate-real-world-experience-from-a-tertiary-centre-in-hong-kong/