TY - JOUR
T1 - Comparison of 3-Factor Versus 4-Factor Prothrombin Complex Concentrate with Regard to Warfarin Reversal, Blood Product Use, and Costs
AU - DeAngelo, Jessica
AU - Jarrell, Daniel
AU - Cosgrove, Richard
AU - Camamo, James
AU - Edwards, Christopher
AU - Patanwala, Asad E.
N1 - Funding Information:
1Department of Pharmacy Services, Banner—University Medical Center Tucson, Tucson, AZ; 2Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ. This study was partially funded by a Publication and Research grant from CSL Behring who is the manufacturer of Kcentra. The authors have no conflicts of interest to declare. *Address for correspondence: Asad E. Patanwala, PharmD, MPH, 1295 North Martin, PO Box 210202, Tucson, AZ 85721. E-mail: [email protected]
Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background: Prothrombin complex concentrates (PCCs) are drug products containing varying amounts of vitamin K-dependent coagulation factors II, VII, IX, and X. The evidence comparing 3-factor PCC (3-PCC) versus 4-factor PCC (4-PCC) for warfarin reversal is conflicting. It has been hypothesized that 3-PCC may be less effective than 4-PCC because of relatively lower factor VII content. Study Question: The primary objective of this study was to compare international normalized ratio (INR) reversal between 3-PCC and 4-factor PCC (4-PCC) in warfarin-treated patients. The secondary objectives include comparing blood product use, total reversal costs, and cost-effectiveness between the groups. Study Design: This was a retrospective cohort study conducted in 2 affiliated, academic institutions in the United States. Consecutive adult patients who received 3-PCC or 4-PCC for warfarin reversal were included. Measures and Outcomes: The primary outcome was adequate INR reversal defined as a final INR #1.5. Secondary outcomes were the utilization of plasma, red blood cells and platelets, reversal costs, and the cost-effectiveness ratio. Results: There were 89 patients who were included in the overall cohort (3-PCC 5 57, 4-PCC 5 32). Adequate INR reversal occurred less commonly with 3-PCC (45.6%) compared with 4-PCC (87.5%) (P, 0.001). There was no significant difference in the proportion of patients who received plasma (32% vs. 28%, P 5 0.813), red blood cells (37% vs. 47%, P 5 0.377), or platelets (16% vs. 28%, P 5 0.180) between the 3-PCC and 4-PCC groups, respectively. The median reversal cost of 3-PCC ($3663) was lower than 4-PCC ($5105) (P 5 0.001). The cost-effective ratio favored 4-PCC ($5105/ 87.5% 5 $5834) compared with 3-PCC ($3663/45.6% 5 $8033). Conclusions: Four-PCC was more effective than 3-PCC with regard to INR reversal in patients taking warfarin, but blood product use was similar. Although 4-PCC is associated with increased reversal costs, it may be cost-effective in terms of INR reversal.
AB - Background: Prothrombin complex concentrates (PCCs) are drug products containing varying amounts of vitamin K-dependent coagulation factors II, VII, IX, and X. The evidence comparing 3-factor PCC (3-PCC) versus 4-factor PCC (4-PCC) for warfarin reversal is conflicting. It has been hypothesized that 3-PCC may be less effective than 4-PCC because of relatively lower factor VII content. Study Question: The primary objective of this study was to compare international normalized ratio (INR) reversal between 3-PCC and 4-factor PCC (4-PCC) in warfarin-treated patients. The secondary objectives include comparing blood product use, total reversal costs, and cost-effectiveness between the groups. Study Design: This was a retrospective cohort study conducted in 2 affiliated, academic institutions in the United States. Consecutive adult patients who received 3-PCC or 4-PCC for warfarin reversal were included. Measures and Outcomes: The primary outcome was adequate INR reversal defined as a final INR #1.5. Secondary outcomes were the utilization of plasma, red blood cells and platelets, reversal costs, and the cost-effectiveness ratio. Results: There were 89 patients who were included in the overall cohort (3-PCC 5 57, 4-PCC 5 32). Adequate INR reversal occurred less commonly with 3-PCC (45.6%) compared with 4-PCC (87.5%) (P, 0.001). There was no significant difference in the proportion of patients who received plasma (32% vs. 28%, P 5 0.813), red blood cells (37% vs. 47%, P 5 0.377), or platelets (16% vs. 28%, P 5 0.180) between the 3-PCC and 4-PCC groups, respectively. The median reversal cost of 3-PCC ($3663) was lower than 4-PCC ($5105) (P 5 0.001). The cost-effective ratio favored 4-PCC ($5105/ 87.5% 5 $5834) compared with 3-PCC ($3663/45.6% 5 $8033). Conclusions: Four-PCC was more effective than 3-PCC with regard to INR reversal in patients taking warfarin, but blood product use was similar. Although 4-PCC is associated with increased reversal costs, it may be cost-effective in terms of INR reversal.
KW - Anticoagulants
KW - Blood coagulation factors
KW - Hemorrhage
KW - Warfarin
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U2 - 10.1097/MJT.0000000000000643
DO - 10.1097/MJT.0000000000000643
M3 - Article
C2 - 28763307
AN - SCOPUS:85053890453
SN - 1075-2765
VL - 25
SP - E326-E332
JO - American journal of therapeutics
JF - American journal of therapeutics
IS - 3
ER -