Emergency Oral Anticoagulant Reversal: The Relative Efficacy of Infusions of Fresh Frozen Plasma and Clotting Factor Concentrate on Correction of the Coagulopathy

1997 ◽  
Vol 77 (03) ◽  
pp. 477-480 ◽  
Author(s):  
Mike Makris ◽  
Mike Greaves ◽  
Wendy S Phillips ◽  
Steve Kitchen ◽  
Frits R Rosendaal ◽  
...  
Keyword(s):  
Vitamin K ◽  
Fresh Frozen Plasma ◽  
Factor Ix ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Anticoagulant Reversal ◽  
Fresh Frozen ◽  
Pre Treatment ◽  
Clotting Factor Concentrates ◽  
Frozen Plasma

SummaryHaemorrhage, including intracranial bleeding, is a common, potentially lethal complication of warfarin therapy and rapid and complete reversal of anticoagulation may be life-saving. Fresh frozen plasma (FFP) and vitamin K are most frequently administered. Because of the variable content of vitamin K-dependent clotting factors in FFP, and the effects of dilution, the efficacy of this approach is open to doubt. We have therefore compared the effects of FFP and clotting factor concentrates on the INRs and clotting factor levels of orally anticoagulated subjects requiring rapid correction of their haemostatic defect. In many, the pre-treatment INR was considered to be dangerously above the target therapeutic range. In the 12 patients given FFP, the INR did not completely correct (range 1.6-3.8, mean 2.3) indicating an ongoing anticoagulated state in all. In contrast, the INR in 29 subjects given clotting factor concentrates was completely corrected in 28 (range 0.9-3.8, mean 1.3). Following treatment, marked differences were observed in clotting factor IX levels between the two groups. The median factor IX level was 19 u/dl (range 10-63) following FFP infusion and 68.5 u/dl (range 31-111) following concentrate. In FFP treated patients, poorer responses were also observed for each of the other vitamin K-depen- dent clotting factors but these were less marked than for factor IX, which was present in low concentrations in some batches of FFP. Thus, haemostatically effective levels of factor IX cannot be achieved, in most instances, by the conventional use of FFP in patients requiring reversal of their anticoagulant therapy. Clotting factor concentrates are the only effective option where complete and immediate correction of the coagulation defect is indicated in orally anticoagulated patients with life or limb-threatening haemorrhage.

Clinical Application of Prothrombin Complex Concentrate in Blood Management in Patients

2017 ◽  
Vol 37 (2) ◽  
pp. 49-56
Author(s):  
Sherri Ozawa ◽  
Tiffany Nelson
Keyword(s):  
Vitamin K ◽  
Prothrombin Complex Concentrate ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Drug Discontinuation ◽  
Clotting Factors ◽  
Urgent Surgery ◽  
Anticoagulant Reversal ◽  
Fresh Frozen ◽  
Frozen Plasma

Management of patients receiving anticoagulants is a major factor in achieving better outcomes. Anticoagulant therapy may need to be discontinued or rapidly reversed before urgent surgery or invasive procedures. In these situations, treatment with concentrated vitamin K, fresh frozen plasma, and/or clotting factors can achieve more rapid anticoagulant reversal than can drug discontinuation alone. Activated prothrombin complex concentrate is used to treat hemophiliac patients with acquired factor VIII inhibitors. Nonactivated prothrombin complex concentrates are used for anticoagulant reversal. The concentrates are effective within minutes of dosing, providing a nearly immediate decrease in the international normalized ratio. The concentrates are lyophilized powders that can be quickly reconstituted, do not require ABO blood typing before use, and contain 25 times the concentration of vitamin K–dependent clotting factors compared with fresh frozen plasma. Studies suggest that the concentrates are associated with better clinical end points than is fresh frozen plasma.

Hypercoagulability In Acute Esophageal Variceal Bleeding

1981 ◽  
Author(s):  
E Hiller ◽  
F Hegemann ◽  
H Riess
Keyword(s):  
Gel Filtration ◽  
Fresh Frozen Plasma ◽  
Clotting Factor ◽  
Intensive Care Treatment ◽  
Clotting Factors ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
At Iii ◽  
Fresh Frozen ◽  
Clotting Factor Concentrates

In 15 patients with acute esophageal bleeding selected parameters of hypercoagulability were determined at frequent intervals during intensive care treatment. Estimation of soluble fibrin monomer complexes (SFMC) by gel filtration of plasma samples which were purified by ß-alanine precipitation allowed the determination of the relative amount of SFMC (percentage of SFMC in relation to the total fibrinogen content in plasma). Antithrombin III (AT III) activity was determined photometrically using the chromogenic substance S-2238 and immunologically by one dimensional immunelectrophoresis. Fibrin split products (FSP) were estimated by the staphylococcal clumping test.Increased levels of SFMC were observed in 10 out of 15 patients on admission. A further increase was noted in most patients in whom bleeding persisted and who needed replacement therapy with blood components. Substitution with prothrombin complex concentrates induced acute DIC in two patients with levels of SFMC up to 24 %. AT III was decreased to levels of 30-50 % in 8 patients during the acute illness. A discrepancy between the functional and immunological AT III value was noted in some instances but more often both values were very low.High levels of SFMC in addition to levels of AT III of less than 50 % reflect a serious state of hypercoagulability with a very poor prognosis for the patients. Clotting factor concentrates may be especially thrombogenic in these patients with impaired clearing activity. Fresh frozen plasma and AT III concentrates provide an appropriate source of the most important clotting factors.

Coagulation management in massive transfusion

2006 ◽  
Vol 26 (S 02) ◽  
pp. S15-S20 ◽  
Author(s):  
D. Fries
Keyword(s):  
Blood Loss ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Plasma Therapy ◽  
Coagulation Management ◽  
Fresh Frozen ◽  
Dilutional Coagulopathy ◽  
Frozen Plasma

SummaryWhen no fresh frozen plasma is available, acute major blood loss is compensated above all with crystalloids, colloids and red blood cell concentrates, meaning that all plasma clotting factors are diluted. So far, consumption coagulopathy is almost always accompanied by dilutional coagulopathy. Formulas for calculating critical blood loss and standard coagulation tests are often not helpful in the case of massive transfusion. On the other hand, systems suitable for point of care, such as thrombelastography, have important advantages. In the case of consumption and dilutional coagulopathy plasma coagulation is disturbed and critical values are first seen for fibrinogen. Not only is fibrin polymerization impaired by the bleeding-induced loss and dilution of fibrinogen, but also by interaction with artificial colloids, particularly hydroxyethyl starch and gelatin preparations. Neither fresh frozen plasma therapy nor treatment with clotting factor concentrates has been the subject of detailed clinical study. Large scaled studies are needed to work out guidelines for coagulation management in the case of massive blood loss.

‘Do not Do’ Recommendations in Hemophilia

2020 ◽  
Vol 20 (3) ◽  
pp. 168-174
Author(s):  
Hortensia De la Corte-Rodriguez ◽  
E. Carlos Rodriguez-Merchan ◽  
M. Teresa Alvarez-Roman ◽  
Monica Martin-Salces ◽  
Victor Jimenez-Yuste
Keyword(s):  
Improve Patient Safety ◽  
Health Resources ◽  
Fresh Frozen Plasma ◽  
Factor Ix ◽  
Levels Of Care ◽  
Fresh Frozen ◽  
History Of ◽  
Improve Patient ◽  
Different Levels ◽  
Frozen Plasma

Background: It is important to discard those practices that do not add value. As a result, several initiatives have emerged. All of them try to improve patient safety and the use of health resources. Purpose: To present a compendium of "do not do recommendations" in the context of hemophilia. Methods: A review of the literature and current clinical guidelines has been made, based on the best evidence available to date. Results: The following 13 recommendations stand out: 1) Do not delay the administration of factor after trauma; 2) do not use fresh frozen plasma or cryoprecipitate; 3) do not use desmopressin in case of hematuria; 4) do not change the product in the first 50 prophylaxis exposures; 5) do not interrupt immunotolerance; 6) do not administer aspirin or NSAIDs; 7) do not administer intramuscular injections; 8) do not do routine radiographs of the joint in case of acute hemarthrosis; 9) Do not apply closed casts for fractures; 10) do not discourage the performance of physical activities; 11) do not deny surgery to a patient with an inhibitor; 12) do not perform instrumental deliveries in fetuses with hemophilia; 13) do not use factor IX (FIX) in patients with hemophilia B with inhibitor and a history of anaphylaxis after administration of FIX. Conclusions: The information mentioned previously can be useful in the management of hemophilia, from different levels of care. As far as we know, this is the first initiative of this type regarding hemophilia.

scholarly journals Geographic differences in hemophilia-associated AIDS incidence in Pennsylvania. By the Pennsylvania AIDS Surveillance Study Group

Blood ◽  
1987 ◽  
Vol 70 (4) ◽  
pp. 1208-1210 ◽  
Keyword(s):  
Blood Product ◽  
Fresh Frozen Plasma ◽  
Factor Ix ◽  
Antibody Prevalence ◽  
Product Usage ◽  
Fresh Frozen ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Hemophilia Treatment Centers ◽  
Frozen Plasma

A 1986 survey of seven hemophilia treatment centers in Pennsylvania (PA) has revealed that 22 hemophiliacs residing in PA have developed the acquired immunodeficiency syndrome (AIDS), representing 9.2% of the total 238 United States hemophiliac AIDS cases. These 22 included ten (45.5%) from western PA (W-PA), eleven (50.0%) from central PA (C-PA), and one (0.5%) from eastern PA (E-PA). The HIV antibody prevalence for these three geographic groups is comparable, with 84 of 178 (47.2%) of hemophiliacs in W-PA seropositive, 102 of 182 (56.0%) in C-PA seropositive, and 105 of 177 (59.3%) in E-PA seropositive. Blood product usage for these three areas is comparable: 47.8 X 10(3) (W-PA) v 43.9 (C-PA) v 53.3 (E-PA) units factor VIII concentrate per patient per year; 36.5 v 24.5 v 33.7 for factor IX concentrate; 8.4 v 4.7 v 7.7 for cryoprecipitate; and 1.3 v 2.7 v 1.0 for fresh frozen plasma, respectively. These data demonstrate a geographic variation in hemophilia AIDS incidence in PA, with a tenfold higher incidence in W- PA and C-PA than E-PA, which is unrelated to differences in HIV antibody prevalence, patient blood product usage, or inaccuracies in AIDS case reporting. Because of the greater than or equal to 5 year median latency between HIV infection and development of AIDS, the AIDS incidence will continue to change, but other factors appear to be operative in the development of AIDS in hemophiliacs.

Prothrombin Complex Concentrates are Superior to Fresh Frozen Plasma for Emergency Reversal of Vitamin K Antagonists: A Meta-Analysis in 2606 Subjects

Drugs ◽  
2019 ◽  
Vol 79 (14) ◽  
pp. 1557-1565 ◽  
Author(s):  
Robert Hill ◽  
Thang S. Han ◽  
Irina Lubomirova ◽  
Nikhil Math ◽  
Paul Bentley ◽  
...  
Keyword(s):  
Vitamin K ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Fresh Frozen Plasma ◽  
Prothrombin Complex Concentrates ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Recent advances in use of fresh frozen plasma, cryoprecipitate, immunoglobulins, and clotting factors for transfusion support in patients with hematologic disease

2020 ◽  
Vol 57 (2) ◽  
pp. 73-82
Author(s):  
Prajeeda M. Nair ◽  
Matthew J. Rendo ◽  
Kristin M. Reddoch-Cardenas ◽  
Jason K. Burris ◽  
Michael A. Meledeo ◽  
...  
Keyword(s):  
Fresh Frozen Plasma ◽  
Clotting Factors ◽  
Hematologic Disease ◽  
Recent Advances ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Geographic differences in hemophilia-associated AIDS incidence in Pennsylvania. By the Pennsylvania AIDS Surveillance Study Group

Blood ◽  
1987 ◽  
Vol 70 (4) ◽  
pp. 1208-1210 ◽  
Keyword(s):  
Blood Product ◽  
Fresh Frozen Plasma ◽  
Factor Ix ◽  
Antibody Prevalence ◽  
Product Usage ◽  
Fresh Frozen ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Hemophilia Treatment Centers ◽  
Frozen Plasma

Abstract A 1986 survey of seven hemophilia treatment centers in Pennsylvania (PA) has revealed that 22 hemophiliacs residing in PA have developed the acquired immunodeficiency syndrome (AIDS), representing 9.2% of the total 238 United States hemophiliac AIDS cases. These 22 included ten (45.5%) from western PA (W-PA), eleven (50.0%) from central PA (C-PA), and one (0.5%) from eastern PA (E-PA). The HIV antibody prevalence for these three geographic groups is comparable, with 84 of 178 (47.2%) of hemophiliacs in W-PA seropositive, 102 of 182 (56.0%) in C-PA seropositive, and 105 of 177 (59.3%) in E-PA seropositive. Blood product usage for these three areas is comparable: 47.8 X 10(3) (W-PA) v 43.9 (C-PA) v 53.3 (E-PA) units factor VIII concentrate per patient per year; 36.5 v 24.5 v 33.7 for factor IX concentrate; 8.4 v 4.7 v 7.7 for cryoprecipitate; and 1.3 v 2.7 v 1.0 for fresh frozen plasma, respectively. These data demonstrate a geographic variation in hemophilia AIDS incidence in PA, with a tenfold higher incidence in W- PA and C-PA than E-PA, which is unrelated to differences in HIV antibody prevalence, patient blood product usage, or inaccuracies in AIDS case reporting. Because of the greater than or equal to 5 year median latency between HIV infection and development of AIDS, the AIDS incidence will continue to change, but other factors appear to be operative in the development of AIDS in hemophiliacs.

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