Prothrombin Complex Concentrate for Non-Bleeding Urgent Warfarin Reversal in Ventricular Assist Device Patients Undergoing Heart Transplantation

We describe 4-factor prothrombin complex concentrate (4F-PCC) use for this indication. This single center, retrospective chart review included BTTVAD patients who received a heart transplant at Brigham and Women’s Hospital (BWH) from December 2013 to November 2014. Patients who did not receive 4F-PCC were excluded. Twelve BTTVAD patients (mean age 54 years, 58 % male, INR of 2.7 ± 0.8) were admitted for urgent heart transplantation. To reverse the INR prior to surgery, patients received a combination of interruption of warfarin and administration of vitamin K, 4F-PCC, and fresh frozen plasma (FFP). All patients received vitamin K at varied routes and doses along with 3 ± 2 units of FFP. Patients received 4F-PCC 25–50 units/kg IV before surgery, and most INR values were less than 2.0 within 1 h of surgical incision. Anticoagulation was effectively reversed with an INR of 1.4 ± 0.1 at completion of surgery. Zero patients required reoperation for bleeding, and there was one death within 30 days. Our results suggest that 4F-PCC 25–50 units/kg IV with vitamin K will achieve rapid, complete, and sustained anticoagulation reversal for BTTVAD patients requiring non-bleeding urgent warfarin reversal for heart transplant.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research