Three-factor prothrombin complex concentrate and hemostasis after high-risk cardiovascular surgery

Abstract Background Cumulative evidence has shown that the non-invasive modality of coronary computed tomography angiography (CCTA) has evolved as an alternative to invasive coronary angiography, which can be used to quantify plaque burden and stenosis and identify vulnerable plaque, assisting in diagnosis, prognosis and treatment. With the increasing elderly population, many patients scheduled for non-cardiovascular surgery may have concomitant coronary artery disease (CAD). The aim of this study was to investigate the usefulness of preoperative CCTA to rule out or detect significant CAD in this cohort of patients and the impact of CCTA results to clinical decision-making. Methods 841 older patients (age 69.5 ± 5.8 years, 74.6% males) with high risk non-cardiovascular surgery including 771 patients with unknown CAD and 70 patients with suspected CAD who underwent preoperative CCTA were retrospectively enrolled. Multivariate logistic regression analysis was performed to determine predictors of significant CAD and the event of cancelling scheduled surgery in patients with significant CAD. Results 677 (80.5%) patients had non-significant CAD and 164 (19.5%) patients had significant CAD. Single-, 2-, and 3- vessel disease was found in 103 (12.2%), 45 (5.4%) and 16 (1.9%) patients, respectively. Multivariate analysis demonstrated that positive ECG analysis and Agatston score were independently associated with significant CAD, and the optimal cutoff of Agatston score was 195.9. The event of cancelling scheduled surgery was increased consistently according to the severity of stenosis and number of obstructive major coronary artery. Multivariate analysis showed that the degree of stenosis was the only independent predictor for cancelling scheduled surgery. In addition, medication using at perioperative period increased consistently according to the severity of stenosis. Conclusions In older patients referred for high risk non-cardiovascular surgery, preoperative CCTA was useful to rule out or detect significant CAD and subsequently influence patient disposal. However, it might be unnecessary for patients with negative ECG and low Agatston score. Trial registration Retrospectively registered.

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The Use of 3- and 4-Factor Prothrombin Complex Concentrate in Patients With Elevated INR

Journal of Pharmacy Practice ◽

10.1177/0897190017707119 ◽

2017 ◽

Vol 31 (3) ◽

pp. 262-267 ◽

Cited By ~ 2

Author(s):

Sanjay Mohan ◽

Mary Ann Howland ◽

Daniel Lugassy ◽

Jessica Jacobson ◽

Mark K. Su

Keyword(s):

Liver Disease ◽

Retrospective Analysis ◽

Prothrombin Complex Concentrate ◽

Coagulation Factor ◽

International Normalized Ratio ◽

Factor Ix ◽

Underlying Liver Disease ◽

Off Label ◽

Coagulation Factor Ix ◽

Three Factor

Background: PCC (Kcentra®) is an Food and Drug Administration (FDA)–approved 4-factor PCC used for the treatment of warfarin-related coagulopathy (WRC), but it has also been used off-label to treat non-WRC. Three-factor PCC in the form of coagulation factor IX human (Bebulin®) has also been used for WRC and off-label to treat non-WRC. It is unclear whether the use of 3- or 4-factor PCCs is effective for the treatment of non-WRC,. Objective: Our aim is to characterize the use of 3- and 4-factor PCCs for patients identified with a non-WRC. Methods: A retrospective analysis of patients who received PCCs for both WRC and non-WRC between January 2012 and July 2015 was conducted. Results: A total of 187 patients with elevated international normalized ratio (INR) who received PCCs were analyzed; 53.9% of patients in the WRC group and 27.7% in the non-WRC group corrected to an INR of 1.3 or less after 3- or 4-factor PCC administration. In those patients with non-WRC and who had underlying liver disease, 3- and 4-factor PCCs reduced mean INR by 0.98 and 1.43, respectively. Conclusion: Three and 4-factor PCCs can reduce INR in patients with WRC and in those with non-WRC secondary to liver disease.

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Clinical Experience With Three-Factor Prothrombin Complex Concentrate to Reverse Warfarin Anticoagulation in Intracranial Hemorrhage

Stroke ◽

10.1161/strokeaha.112.661454 ◽

2012 ◽

Vol 43 (9) ◽

pp. 2500-2502 ◽

Cited By ~ 36

Author(s):

Jeffrey A. Switzer ◽

Jody Rocker ◽

Phillip Mohorn ◽

Jennifer L. Waller ◽

Douglas Hughes ◽

...

Keyword(s):

Clinical Experience ◽

Intracranial Hemorrhage ◽

Prothrombin Complex Concentrate ◽

Three Factor

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Introducing Advance Care Planning Prior to High-Risk Operations: A Pilot Project in the Cardiovascular Surgery Department

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2016.07.579 ◽

2016 ◽

Vol 32 (10) ◽

pp. S329

Author(s):

T. Killackey ◽

J. MacIver ◽

P. Murphy ◽

H. Storey ◽

M. Eason ◽

...

Keyword(s):

High Risk ◽

Advance Care Planning ◽

Cardiovascular Surgery ◽

Pilot Project ◽

Care Planning ◽

Advance Care ◽

Surgery Department

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Do factors matter for predicting high-risk stock returns? Comparison of single-, three- and five-factor CAPM

International Journal of Financial Engineering ◽

10.1142/s2424786319500154 ◽

2019 ◽

Vol 06 (02) ◽

pp. 1950015

Author(s):

Muhammad Adnan Arshad ◽

Saira Munir ◽

Bashir Ahmad ◽

Muhammad Waseem

Keyword(s):

High Risk ◽

Stock Returns ◽

Financial Sector ◽

Fixed Effect Model ◽

Fixed Effect ◽

Single Factor ◽

Hausman Test ◽

Effect Model ◽

Three Factor

This study empirically analyzes the three models of CAPM in order to get the best determinants, and superlative model of CAPM in the context of Pakistan’s Financial Sector. This study used fixed Effect model and Hausman test are used in this study to investigate the single-, three- and five-factor CAPM. First we analyzed the single factor CAPM, and results explain 52% variations in the dependent variable — stock returns. Next, the three-factors CAPM is analyzed, which elucidates 69% variations in the dependent variable — stock returns — on the addition of two more factors (size and value). Lastly, five factor CAPM is estimated, which provides 76% variations in the dependent variable — stock returns — by adding two more factors (investment and profitability) in the three factor CAPM. This shows that the addition of more factors in the CAPM bestows suitable results in the financial sector of Pakistan.

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Suboptimal effect of a three-factor prothrombin complex concentrate (Profilnine-SD) in correcting supratherapeutic international normalized ratio due to warfarin overdose

Transfusion ◽

10.1111/j.1537-2995.2008.02080.x ◽

2009 ◽

Vol 49 (6) ◽

pp. 1171-1177 ◽

Cited By ~ 148

Author(s):

Lorne Holland ◽

Theodore E. Warkentin ◽

Majed Refaai ◽

Mark A. Crowther ◽

Marilyn A. Johnston ◽

...

Keyword(s):

Prothrombin Complex Concentrate ◽

International Normalized Ratio ◽

Three Factor

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Should Volume Standards for Cardiovascular Surgery Focus Only on High-Risk Patients?

Circulation ◽

10.1161/01.cir.0000051721.60127.ea ◽

2003 ◽

Vol 107 (3) ◽

pp. 384-387 ◽

Cited By ~ 37

Author(s):

Philip P. Goodney ◽

F.L. Lucas ◽

John D. Birkmeyer

Keyword(s):

High Risk ◽

Cardiovascular Surgery ◽

High Risk Patients ◽

Risk Patients

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Propensity Score Adjusted Comparison of Three-Factor versus Four-Factor Prothrombin Complex Concentrate for Emergent Warfarin Reversal: A Retrospective Cohort Study

10.21203/rs.3.rs-35228/v1 ◽

2020 ◽

Author(s):

David Margraf ◽

Scott Seaburg ◽

Gregory Beilman ◽

Julian Wolfson ◽

Jonathan Gipson ◽

...

Keyword(s):

Propensity Score ◽

Hospital Stay ◽

Prothrombin Complex Concentrate ◽

Primary Outcome ◽

Patient Characteristics ◽

International Normalized Ratio ◽

Academic Level ◽

Warfarin Reversal ◽

Propensity Score Adjustment ◽

Three Factor

Abstract Background Prothrombin Complex Concentrates are prescribed for emergent warfarin reversal (EWR). Few direct comparisons with three-factor prothrombin complex concentrate (PCC3) and four-factor prothrombin complex concentrate (PCC4) exist. Patients in an academic level one trauma center who received PCC3 or PCC4 for EWR were identified. Patient characteristics, PCC dose and time of dose, pre- and post-INR and time of measurement, plasma and vitamin K doses, and patient outcomes were collected. Patients whose pre-PCC International Normalized Ratio (INR) was > 6 hours before PCC dose or the pre-post PCC INR was > 12 hours were excluded. The primary outcome was achieving an INR ≤ 1.5 post PCC. Secondary outcomes were the change in INR over time, post PCC INR, thromboembolic events (TE), and death during hospital stay. Logistic regression modelled the primary outcome with and without a propensity score adjustment accounting for age, sex, actual body weight, dose, initial INR value, and time between INR measurements. Data are reported as median (IQR) or n (%) with p < 0.05 considered significant. Results Eighty patients were included (PCC3 = 57, PCC4 = 23). More PCC4 patients achieved goal INR (87.0% vs. 31.6%, odds ratio (OR) = 14.4, 95% CI: 3.80-54.93, p < 0.001). The result was similar after adjusting for possible confounders (AOR = 10.7, 95% CI: 2.17–51.24, p < 0.001). The post-PCC INR was lower in the PCC4 group (1.3 (1.3–1.5) vs. 1.7 (1.5-2.0), p < 0.001. The INR change was greater for PCC4 (2.3 (1.3–3.3) vs. 1.1 (0.6-2.0), p = 0.003). Death during hospital stay (p = 0.52) and TE (p = 1.00) were not significantly different. Conclusions PCC4 was associated with a higher achievement of goal INR than PCC3. This relationship was observed in the unadjusted, propensity score adjusted, and time stratified results.

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