Abstract Number: PB1112
Meeting: ISTH 2020 Congress
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%|
[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|
[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 January 28, 2022.
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