Prothrombin Complex Concentrate in the Management of Major Bleeding Induced By Oral Anticoagulant Therapy: Experience of a Tertiary Care Center

Background In patients taking oral anticoagulants and presenting with major bleeding, a rapid, effective, and safe reversal agent is urgently required. There are limited data of 4-factor prothrombin complex concentrate (4F-PCC) in the management of oral anticoagulant associated major bleeding. Aims The purpose of this study is to provide clinical experience regarding the effectiveness of 4F-PCC in the management of major bleeding induced by warfarin, dabigatran, and rivaroxaban. Methods A retrospective study of 43 patients who were admitted to our tertiary care center with major bleeding induced by oral anticoagulants and received 4F-PCC. The effectiveness of PCCs was assessed by using the International Society of Thrombosis and Hemostasis criteria. Descriptive statistics were utilized for analysis. Results Forty-three patients were screened for inclusion into the study; notably, 21% of patients were excluded from further analysis. Of those included in this analysis (n=22), gastrointestinal bleeding accounted for (45.5%), followed by musculoskeletal bleeding (18.2%). The indication for anticoagulation was stroke prevention atrial fibrillation and VTE in the majority of the patients (45.5%), (45.5%) respectively. Patients received a mean of 2085.2 IU of PCC. Before and after 24 hours of PCC administration, the median INR resulted in a significant reduction (P;