A retrospective comparison of the emergent use of fixed-dose four-factor prothrombin complex versus weight-based dosing for intracranial hemorrhage assessing medication delivery time and cost

Gordon M Riha; Michael S Englehart; Karin Z Walton; Megan E Saunders; Benjamin T Carter; Simon J Thompson

A retrospective comparison of the emergent use of fixed-dose four-factor prothrombin complex versus weight-based dosing for intracranial hemorrhage assessing medication delivery time and cost

Int J Physiol Pathophysiol Pharmacol. 2023 Jun 15;15(3):98-104. eCollection 2023.

Authors

Gordon M Riha¹, Michael S Englehart¹, Karin Z Walton², Megan E Saunders³, Benjamin T Carter⁴, Simon J Thompson⁴

Affiliations

¹ Trauma & General Surgery, Billings Clinic Billings, MT, USA.
² Pharmacy, Billings Clinic Billings, MT, USA.
³ Pharmacy Informatics, Billings Clinic Billings, MT, USA.
⁴ Collaborative Science & Innovation, Billings Clinic Billings, MT, USA.

PMID: 37457648
PMCID: PMC10349319

Abstract

Objectives: The goal of this study was to evaluate a low fixed-dose versus weight-based dosing strategy for four-factor prothrombin complex (4F-PCC) time to administration in intracranial hemorrhage (ICH) patients.

Methods: A retrospective analysis was conducted at a single rural Tertiary referral center in patients ≥18 years old on warfarin with ICH who received 4F-PCC. Continuous variables were summarized using mean (±95% CI) and compared using two-tailed tests; p values ≤0.05 were considered statistically significant.

Results: A total of 46 ICH patients were reversed using 4F-PCC (Fixed, n = 27 and Weight, n = 19). Baseline characteristics were equivalent. Total units of 4F-PCC (mean dose units 2525.1 versus 1623.3) and dose per kg were significantly reduced in the fixed-dose group. Total time from order to delivery was significantly reduced with the fixed-dose strategy (mean time 43.0 versus 29.0 minutes). Hospital length of stay (LOS), intensive care unit LOS, and mortality were equivalent with a similar mechanism. International Normalized Ratio (INR) reversal success (≤1.5) and total INR change was comparable with no difference in adverse thromboses between groups.

Conclusions: A fixed-dosed strategy reduced time to 4F-PCC administration for warfarin reversal in ICH, as compared to a weight-based strategy; with no increase in LOS, mortality, or need for additional dosing. This also resulted in significant cost savings.

Keywords: Warfarin; four-factor prothrombin complex concentrate; international normalized ratio; intracranial hemorrhage.