Activated prothrombin complex concentrate achieves haemostasis in major bleeding

In patients with major bleeding being managed with warfarin, the use of activated prothrombin complex concentrate (aPCC) is effective in achieving clinical haemostasis, a recent study has found.

Researchers conducted a retrospective study of 67 patients (mean age 72.8 years, 61.1 percent men) who presented with major bleeding while on warfarin. The efficacy of aPCC for achieving haemostasis was assessed according to standards of the International Society of Thrombosis and Haemostasis, as well as by reaching an International Normalization Ratio (INR) <1.5 after administration.

More than half (55.2 percent) of patients presented with intracranial haemorrhage, while nearly half were taking warfarin for atrial fibrillation (47.8 percent). Nineteen patients had INR ≥5 upon admission and were given 1,000 units of aPCC; the remaining 48 patients had INR <5 at admission and received 500-unit aPCC doses.

Overall, 46 patients achieved effective haemostasis, yielding a rate of 68.7 percent. Moreover, 39 patients (58.2 percent) reached INR <1.5 after treatment with aPCC. Of the 21 patients who did not achieve haemostasis, 16 died.

Analysing according to total body weight did not affect the primary findings. Of the 21 patients deemed obese, 66.7 percent achieved haemostasis while 66.7 percent reached INR <1.5; six of these patients died. Rates of haemostasis (p=0.498), INR <1.5 (p=0.6622), and mortality (p=0.91) were comparable to patients who were not obese.

“Further controlled studies are needed to confirm these findings and conclude the optimal dosing regimen for maximal efficacy and safety,” the researchers said.