In this episode, I’ll discuss Low dose versus standard dose four-factor prothrombin complex concentrate for factor‐Xa inhibitor reversal in spontaneous and traumatic intracranial hemorrhage.
While guidelines recommend 50 units/kg when 4 factor prothrombin complex concentrate (4FPCC) is used for factor‐Xa inhibitor reversal in intracranial hemorrhage, lower doses of 25 units/kg are sometimes used in clinical practice.
Researchers recently published in Pharmacotherapy a retrospective multi-center cohort study looking at hemostatic efficacy when comparing these two doses.
93 patients were analyzed, split almost 2:1 in favor of 25 units/kg. The authors found no difference in hemostatic efficacy between groups (82.3% for 25 units/kg vs. 83.9% for 50 units/kg, p=0.846). In addition, between-group rates were not different for hospital mortality, length of stay, thrombotic events, or the need for surgery or additional blood products.
While there are studies looking at just a 25 unit/kg dose, this is the first study to compare these two doses for reversal of anti-Xa inhibitors. The authors state that prospective randomized controlled trials are needed in order to confirm the results and draw more definitive conclusions about the efficacy and safety of 25 versus 50 units/kg of 4FPCC.
Until then there will likely not be consensus on which dose of 4FPCC to use for factor Xa reversal, and some clinicians may look at this retrospective study as justifying using the lower dose.
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