Background Prothrombin complex concentrate (PCC) can be used for replacement of congenital or acquired vitamin K dependent clotting factor deficiency. Its main indication is to obtain a rapid reversal of oral anticoagulation therapy: vitamin K antagonist (VKA).
Purpose In the light of an increase in PCC consummation in our hospital (2019 beds) during the past 2 years (maybe due to a new use of reversal of new oral anticoagulants (NOACs)) and to promote the respect of recommended indications (AMM, marketing authorisation), we evaluated the clinical use of PCC for the reversal of oral anticoagulation.
Material and methods We retrospectively recorded orders of PPC between January and December 2014. We evaluated the pertinence of the indication for anticoagulation reversal according to national recommendations on management of haemorrhage risk or haemorrhage treatment with anticoagulated patients.
We also assessed prescription quality according to dosage, initial INR (international normalised ratio), patient’s weight, vitamin K association and initial anticoagulation therapy of every patient in accordance with national recommendations, literature recommendations and medication label.
Results There were 106 patients included in this study; 95% were associated with VKA treatment. The majority of indications were justified (80%): 50% for serious haemorrhage and 38% for patients who needed surgery in an emergency. However, there were concerns about PPC dosage used: 41% were not adjusted for weight or initial INR, principally sub-therapeutic doses in 80% of cases. Only 55% of PPC prescriptions were associated with vitamin K; 45% of administrations of PPC were not associated with vitamin K.
Conclusion Thanks to this retrospective evaluation, we have realised that the majority of PPC prescriptions are well justified and within recommended situations; only 5% were used for NOAC reversal. But the study also shows a lack of knowledge about the best dosage of PPC to administrate and the correct associated therapeutics in these situations. The role of the pharmacist is very important in order to promote good clinical drug use and to alert prescribers about PCC prescription recommendations, notably dosage adjustment with the patient’s weight or INR. The results of this study will be presented to main prescribers of PPC and new recommendations will be posted in the care unit.
References and/or Acknowledgements Surdosage VKA HAS 2008
No conflict of interest.
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