Skip to main content
Erschienen in: Internal and Emergency Medicine 2/2019

09.11.2018 | IM - ORIGINAL

Treatment of apixaban- and rivaroxaban-associated major bleeding using 4-factor prothrombin complex concentrate

verfasst von: Marwan Sheikh-Taha

Erschienen in: Internal and Emergency Medicine | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

There is limited clinical experience with the use of coagulation concentrates to reverse the effect of direct oral anticoagulants. We assess the achievement of effective clinical hemostasis with the use of 4-factor prothrombin complex concentrate (PCC) in patients on apixaban or rivaroxaban presenting with major bleeding. A retrospective chart review was conducted at a tertiary referral medical center in the USA. We assess the achievement of clinical hemostasis using 4-factor PCC in patients on chronic apixaban or rivaroxaban therapy presenting with major bleeding. Clinical hemostasis was assessed by the International Society of Thrombosis and Hemostasis Scientific and Standardization Subcommittee criteria. A total of 29 patients are included in the study. The most common site of bleeding was intracranial hemorrhage (ICH) (72.4%), followed by gastrointestinal bleed (13.8%). Clinical hemostasis was achieved in 21 (72.4%) patients. Patients who did not achieve clinical hemostasis (27.6%) suffered from ICH, and all of them died during hospitalization except for two patients who were discharged with neurologic deterioration. One patient developed multiple brain infarctions after receiving 4-factor PCC. Sixteen patients (55.2%) were receiving concomitant medications that interact with apixaban and rivaroxaban and increase the risk of bleeding. Four-factor PCC appears to be effective in achieving clinical hemostasis in patients on apixaban or rivaroxaban presenting with major bleeding. It may be an alternative to patients who need anticoagulation reversal if the specific antidote, andexanet alfa, is not available.
Literatur
1.
Zurück zum Zitat Chai-Adisaksopha C, Hillis C, Isayama T, Lim W, Iorio A, Crowther M (2015) Mortality outcomes in patients receiving direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials. J Thromb Haemost 13(11):2012–2020CrossRefPubMed Chai-Adisaksopha C, Hillis C, Isayama T, Lim W, Iorio A, Crowther M (2015) Mortality outcomes in patients receiving direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials. J Thromb Haemost 13(11):2012–2020CrossRefPubMed
2.
Zurück zum Zitat Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149(2):315–352CrossRefPubMed Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149(2):315–352CrossRefPubMed
3.
Zurück zum Zitat Desai NR, Krumme AA, Schneeweiss S, Shrank WH, Brill G, Pezalla EJ, Spettell CM, Brennan TA, Matlin OS, Avorn J, Choudhry NK (2014) Patterns of initiation of oral anticoagulants in patients with atrial fibrillation—quality and cost implications. AM J Med 127(11):1075–1082CrossRefPubMed Desai NR, Krumme AA, Schneeweiss S, Shrank WH, Brill G, Pezalla EJ, Spettell CM, Brennan TA, Matlin OS, Avorn J, Choudhry NK (2014) Patterns of initiation of oral anticoagulants in patients with atrial fibrillation—quality and cost implications. AM J Med 127(11):1075–1082CrossRefPubMed
4.
Zurück zum Zitat Samuelson BT, Cuker A (2017) Measurement and reversal of the direct oral anticoagulants. Blood Rev 31(1):77–84CrossRefPubMed Samuelson BT, Cuker A (2017) Measurement and reversal of the direct oral anticoagulants. Blood Rev 31(1):77–84CrossRefPubMed
5.
Zurück zum Zitat Cuker A, Siegal D (2015) Monitoring and reversal of direct oral anticoagulants. ASH Education Program Book. 2015(1):117–124 Cuker A, Siegal D (2015) Monitoring and reversal of direct oral anticoagulants. ASH Education Program Book. 2015(1):117–124
6.
Zurück zum Zitat Schulman S (2005) Kearon C (2005) Subcommittee on control of anticoagulation of the scientific and standardization committee of the international society on thrombosis and haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. J Thromb Haemost 3(4):692–694CrossRefPubMed Schulman S (2005) Kearon C (2005) Subcommittee on control of anticoagulation of the scientific and standardization committee of the international society on thrombosis and haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. J Thromb Haemost 3(4):692–694CrossRefPubMed
7.
Zurück zum Zitat Khorsand N, Majeed A, Sarode R, Beyer-Westendorf J, Schulman S, Meijer K (2016) Subcommittee on Control of Anticoagulation. Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH. J Thromb Haemost 14(1):211–244CrossRefPubMed Khorsand N, Majeed A, Sarode R, Beyer-Westendorf J, Schulman S, Meijer K (2016) Subcommittee on Control of Anticoagulation. Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH. J Thromb Haemost 14(1):211–244CrossRefPubMed
8.
Zurück zum Zitat Majeed A, Ågren A, Holmström M, Bruzelius M, Chaireti R, Odeberg J, Hempel EL, Magnusson M, Frisk T, Schulman S (2017) Management of rivaroxaban or apixaban associated major bleeding with prothrombin complex concentrates: a cohort study. Blood 1:blood-2017 Majeed A, Ågren A, Holmström M, Bruzelius M, Chaireti R, Odeberg J, Hempel EL, Magnusson M, Frisk T, Schulman S (2017) Management of rivaroxaban or apixaban associated major bleeding with prothrombin complex concentrates: a cohort study. Blood 1:blood-2017
9.
Zurück zum Zitat Connolly SJ, Milling TJ Jr, Eikelboom JW, Gibson CM, Curnutte JT, Gold A, Bronson MD, Lu G, Conley PB, Verhamme P, Schmidt J (2016) Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med 375(12):1131–1141CrossRefPubMedPubMedCentral Connolly SJ, Milling TJ Jr, Eikelboom JW, Gibson CM, Curnutte JT, Gold A, Bronson MD, Lu G, Conley PB, Verhamme P, Schmidt J (2016) Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med 375(12):1131–1141CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P (2008) Hematoma growth in oral anticoagulant related intracerebral hemorrhage. Stroke 39(11):2993–2996CrossRefPubMed Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P (2008) Hematoma growth in oral anticoagulant related intracerebral hemorrhage. Stroke 39(11):2993–2996CrossRefPubMed
11.
Zurück zum Zitat Hart RG, Boop BS, Anderson DC (1995) Oral anticoagulants and intracranial hemorrhage: facts and hypotheses. Stroke 26(8):1471–1477CrossRefPubMed Hart RG, Boop BS, Anderson DC (1995) Oral anticoagulants and intracranial hemorrhage: facts and hypotheses. Stroke 26(8):1471–1477CrossRefPubMed
12.
Zurück zum Zitat Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24(7):987–993CrossRefPubMed Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24(7):987–993CrossRefPubMed
13.
Zurück zum Zitat Franke CL, Van Swieten JC, Algra A, Van Gijn J (1992) Prognostic factors in patients with intracerebral haematoma. J Neurol Neurosurg Psychiatry 55(8):653–657CrossRefPubMedPubMedCentral Franke CL, Van Swieten JC, Algra A, Van Gijn J (1992) Prognostic factors in patients with intracerebral haematoma. J Neurol Neurosurg Psychiatry 55(8):653–657CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Lexi-Comp, Inc. (2018) (Lexi-Drugs®). Lexi-Comp, Inc. Lexi-Comp, Inc. (2018) (Lexi-Drugs®). Lexi-Comp, Inc.
Metadaten
Titel
Treatment of apixaban- and rivaroxaban-associated major bleeding using 4-factor prothrombin complex concentrate
verfasst von
Marwan Sheikh-Taha
Publikationsdatum
09.11.2018
Verlag
Springer International Publishing
Erschienen in
Internal and Emergency Medicine / Ausgabe 2/2019
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-018-1977-9

Weitere Artikel der Ausgabe 2/2019

Internal and Emergency Medicine 2/2019 Zur Ausgabe

CE - MEDICAL ILLUSTRATION

A sticking sensation in the throat!

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.