Abstract Details

Title Assessing efficacy of four factor prothrombin complex concentrate (4FPCC) for reversal of direct factor Xa inhibitors in intracranial hemorrhages at an academic medical center

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P16 - Poster Session 16 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-004

Objective

This study was conducted to analyze hemostatic efficacy and safety of four factor pro-thrombin complex concentrate (4F-PCC) as a reversal agent for the direct factor Xa inhibitors.

Background Limited data exists for the use of 4F-PCC for the reversal of bleeding associated with the direct factor Xa inhibitors. This represents a significant gap in the literature given the steadily increasing use of factor Xa inhibitors for anti-coagulation.

Design/Methods

This study was a retrospective, observational review of adult patients (≥18 years) who received 4F-PCC for the reversal of apixaban or rivaroxaban associated bleeding between October 1, 2015 and May 30, 2019. Patients with warfarin related bleeds were excluded. Hemostatic efficacy for intracranial bleeds was defined by a stable or less than 35% increase in hematoma volume on follow up computerized tomography (CT).

Results We found 46 patients meeting inclusion criteria. Of these, 26 had an intracranial bleed and were used for further analysis. The majority were traumatic subdural or subarachnoid hemorrhages (35%), followed by intraparenchymal hemorrhage (19%). The mean age was 76.2 years. Most (20 patients, 76.9%) received reversal for an apixaban associated bleed, while the remaining (6 patients, 23.1%) had a rivaroxaban associated bleed. The majority of patients (86%) had unknown time of last factor Xa inhibitor dose. Half of the patients had an emergent neurosurgical intervention. The most common interventions were craniotomy (31%), craniectomy (31%) and hemicraniectomy (23%). The mean 4FPCC dose was 34.8 units/kg. Most patients had stable hematoma volume on follow up CT imaging (19 of 23 patients, 83 %). Only one patient developed a deep vein thrombosis.

Conclusions Most patients who received 4F-PCC achieved clinical hemostasis of their bleed as assessed by stable CT scan. Patients who did not survive their hospital admission generally had poor prognosis on admission. Incidence of deep vein thrombosis associated with 4F-PCC was very low.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Klepper Alfredo Garcia, MD (Augusta University - Neurocritical Care Division)	Dr. Garcia has nothing to disclose.
Manan Shah, MD, MBBS (Augusta University Medical Center, Dept Of Neurology)	Dr. Shah has nothing to disclose.

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