A Comparison of Human Prothrombin Complex and Fresh Frozen Plasma for Reversal of Warfarin Anticoagulant Effect in The Emergency Department

Abstract

Introduction: Warfarin, the most commonly used oral anticoagulant worldwide. Bleeding represents the most significant complication of warfarin therapy. The aim of the present study was to compare the efficacies of Human Prothrombin Complex (PCC) and Fresh Frozen Plasma (FFP) for reversal of warfarin-induced anticoagulant effect in the emergency department.

Materials and methods: This observational, retrospective study was retrospectively conducted at Sisli Hamidiye Etfal Training and Research Hospital. The study included 32 patients aged over 18 years who presented to the emergency department with warfarin-induced INR elevation and major bleeding. The patients were divided into PCC (Group 1) and FFP (Group 2) groups. The two groups were compared with each other with respect to age, gender distribution, duration of emergency department stay, warfarin dosing schedule (mg/day), bleeding site, amount of PCC (number*10 ml/IU) or FFP (number*200 ml) used for treatment, pre-treatment INR, aPTT levels, and INR, PT, and aPTT levels 15 minutes after FFP and 240 minutes after PCC administration.

Results: The two groups were not significantly different with respect to age and gender distribution (p > 0.05). PCC group had an average duration of emergency department stay of 4.8 hours whereas FFP group had an average duration of emergency department stay of 12.25 hours (p<0.05). The number and cost of PCC was significantly greater than FFP (p<0.05). However, the volume of drug was significantly lower in the PCC group (p<0.05)

Conclusion: PCC has a limited role in clinical practice due to its cost and limited availability. However, with the possible exceptions of blood transmissible diseases, volume loading, and loss of time, administration of a combination of FFP and vitamin K is not a medically inappropriate practice.