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Safety of a Four‐factor Prothrombin Complex Concentrate Versus Plasma for Vitamin K Antagonist Reversal: An Integrated Analysis of Two Phase III b Clinical Trials
Author(s) -
Milling Truman J.,
Refaai Majed A.,
Sarode Ravi,
Lewis Brandon,
Mangione Antoinette,
Durn Billie L.,
Harman Amy,
Lee Martin L.,
Goldstein Joshua N.
Publication year - 2016
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12911
Subject(s) - medicine , prothrombin complex concentrate , vitamin k antagonist , vitamin k , adverse effect , randomized controlled trial , clinical trial , prothrombin time , prothrombin complex , surgery , gastroenterology , coagulation , warfarin , atrial fibrillation
Abstract Objectives Clinicians often need to rapidly reverse vitamin K antagonists ( VKA s) in the setting of major hemorrhage or urgent need for surgery. Little is known about the safety profile of the traditional reversal agent, plasma, or the newly approved agent, four‐factor prothrombin complex concentrate (4F‐ PCC ), in a randomized setting. This is an integrated analysis of safety data from two clinical trials that evaluated 4F‐ PCC versus plasma for the treatment of patients requiring rapid VKA reversal for acute major bleeding or prior to an urgent surgical/invasive procedure. Methods This descriptive analysis comprised adverse event ( AE ) data from two phase III b, randomized, controlled trials. The bleeding and surgical studies were performed across 36 and 33 sites, respectively, in nine countries, with the integrated analysis comprising 388 patients (4F‐ PCC , n = 191; plasma, n = 197) aged ≥ 18 years, who required VKA reversal due to major bleeding or prior to an urgent surgical/invasive procedure. Patients received either 4F‐ PCC , containing nonactivated factors II , VII , IX , and X and proteins C and S (Beriplex/Kcentra, CSL Behring) or plasma, both dosed according to baseline international normalized ratio and body weight. Patients were also to receive vitamin K1. AE s and serious AE s ( SAE s) were assessed up to days 10 and 45, respectively. Results The proportion of patients with AE s (4F‐ PCC , 115/191 [60.2%]; plasma, 124/197 [62.9%]) and SAE s (4F‐ PCC , 54/191 [28.3%]; plasma, 49/197 [24.9%]) was similar between groups. The proportion of patients with thromboembolic events was also similar between groups (4F‐ PCC , 14/191 [7.3%]; plasma, 14/197 [7.1%]). There were 13 (6.8%) deaths in the 4F‐ PCC group and 13 (6.6%) in the plasma group. Fluid overload events occurred in more patients in the plasma group than the 4F– PCC group (25 [12.7%] and 9 [4.7%], respectively). Conclusions These safety data represent the largest controlled assessment of a 4F‐ PCC to date. For patients requiring urgent VKA reversal, 4F‐ PCC had a safety profile similar to that of plasma ( AE s, SAE s, thromboembolic events, and deaths), but was associated with fewer fluid overload events.