Publication

A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy

Khorsand, N., Kooistra, H. A. M., van Hest, R. M., Veeger, N. J. G. M. & Meijer, K., Jan-2015, In : Thrombosis Research. 135, 1, p. 9-19 11 p.

Research output: Contribution to journalReview articleAcademicpeer-review

APA

Khorsand, N., Kooistra, H. A. M., van Hest, R. M., Veeger, N. J. G. M., & Meijer, K. (2015). A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy. Thrombosis Research, 135(1), 9-19. https://doi.org/10.1016/j.thromres.2014.11.019

Author

Khorsand, Nakisa ; Kooistra, Hilde A. M. ; van Hest, Reinier M. ; Veeger, Nic J. G. M. ; Meijer, Karina. / A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy. In: Thrombosis Research. 2015 ; Vol. 135, No. 1. pp. 9-19.

Harvard

Khorsand, N, Kooistra, HAM, van Hest, RM, Veeger, NJGM & Meijer, K 2015, 'A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy', Thrombosis Research, vol. 135, no. 1, pp. 9-19. https://doi.org/10.1016/j.thromres.2014.11.019

Standard

A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy. / Khorsand, Nakisa; Kooistra, Hilde A. M.; van Hest, Reinier M.; Veeger, Nic J. G. M.; Meijer, Karina.

In: Thrombosis Research, Vol. 135, No. 1, 01.2015, p. 9-19.

Research output: Contribution to journalReview articleAcademicpeer-review

Vancouver

Khorsand N, Kooistra HAM, van Hest RM, Veeger NJGM, Meijer K. A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy. Thrombosis Research. 2015 Jan;135(1):9-19. https://doi.org/10.1016/j.thromres.2014.11.019


BibTeX

@article{dd3f867d103b488a9356deda491302f0,
title = "A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy",
abstract = "Management of patients with a major bleed while on vitamin K antagonist (VKA) is a common clinical challenge. Prothrombin Complex Concentrates (PCC) provide a rapid reversal of VKA induced coagulopathy. However, a well-defined PCC dosing strategy, especially in emergency setting, is still lacking.We performed a systematic review to describe the currently used PCC dosing strategies and to present their efficacy in terms of target INR achievement and clinical outcome. We used outcome definitions as used in the individual studies.MEDLINE and EMBASE databases were searched for studies reporting the use of PCC for emergency VKA reversal. Twenty-eight studies, including 4 randomized trials, were found. In these, fifteen different PCC dosing protocols were identified in which the PCC dose ranged from 8 to 50 IU factor IX/kg. These strategies were based on: bodyweight; bodyweight and initial INR; bodyweight and initial INR and target INR; individual doctors decision; or a fixed dose. Study quality was moderate with large variation in outcome definitions.Relatively good clinical and INR outcomes were reported with the use of any treatment protocol while less good results were reported for INR outcome when a predefined protocol was missing (doctor strategy). Lowest PCC dosages were infused in the fixed dose strategy.In emergency VKA reversal, a predefined PCC dosing protocol seems essential. We found no evidence that one dosing strategy is superior. Future studies should be designed to investigate if body weight and INR are relevant for PCC dosing. In these, we need uniform outcome definitions. (C) 2014 Elsevier Ltd. All rights reserved.",
keywords = "Hematology (hemostasis and thrombosis), oral anticoagulants, Vitamin-K dependent coagulation proteins, prothrombin complex concentrates, ORAL ANTICOAGULANT-THERAPY, EMERGENCY REVERSAL, WARFARIN REVERSAL, INTRACRANIAL HEMORRHAGE, RAPID REVERSAL, SAFETY, EFFICACY, METAANALYSIS, FRENCH, TRIAL",
author = "Nakisa Khorsand and Kooistra, {Hilde A. M.} and {van Hest}, {Reinier M.} and Veeger, {Nic J. G. M.} and Karina Meijer",
year = "2015",
month = "1",
doi = "10.1016/j.thromres.2014.11.019",
language = "English",
volume = "135",
pages = "9--19",
journal = "Thrombosis Research",
issn = "0049-3848",
publisher = "PERGAMON-ELSEVIER SCIENCE LTD",
number = "1",

}

RIS

TY - JOUR

T1 - A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy

AU - Khorsand, Nakisa

AU - Kooistra, Hilde A. M.

AU - van Hest, Reinier M.

AU - Veeger, Nic J. G. M.

AU - Meijer, Karina

PY - 2015/1

Y1 - 2015/1

N2 - Management of patients with a major bleed while on vitamin K antagonist (VKA) is a common clinical challenge. Prothrombin Complex Concentrates (PCC) provide a rapid reversal of VKA induced coagulopathy. However, a well-defined PCC dosing strategy, especially in emergency setting, is still lacking.We performed a systematic review to describe the currently used PCC dosing strategies and to present their efficacy in terms of target INR achievement and clinical outcome. We used outcome definitions as used in the individual studies.MEDLINE and EMBASE databases were searched for studies reporting the use of PCC for emergency VKA reversal. Twenty-eight studies, including 4 randomized trials, were found. In these, fifteen different PCC dosing protocols were identified in which the PCC dose ranged from 8 to 50 IU factor IX/kg. These strategies were based on: bodyweight; bodyweight and initial INR; bodyweight and initial INR and target INR; individual doctors decision; or a fixed dose. Study quality was moderate with large variation in outcome definitions.Relatively good clinical and INR outcomes were reported with the use of any treatment protocol while less good results were reported for INR outcome when a predefined protocol was missing (doctor strategy). Lowest PCC dosages were infused in the fixed dose strategy.In emergency VKA reversal, a predefined PCC dosing protocol seems essential. We found no evidence that one dosing strategy is superior. Future studies should be designed to investigate if body weight and INR are relevant for PCC dosing. In these, we need uniform outcome definitions. (C) 2014 Elsevier Ltd. All rights reserved.

AB - Management of patients with a major bleed while on vitamin K antagonist (VKA) is a common clinical challenge. Prothrombin Complex Concentrates (PCC) provide a rapid reversal of VKA induced coagulopathy. However, a well-defined PCC dosing strategy, especially in emergency setting, is still lacking.We performed a systematic review to describe the currently used PCC dosing strategies and to present their efficacy in terms of target INR achievement and clinical outcome. We used outcome definitions as used in the individual studies.MEDLINE and EMBASE databases were searched for studies reporting the use of PCC for emergency VKA reversal. Twenty-eight studies, including 4 randomized trials, were found. In these, fifteen different PCC dosing protocols were identified in which the PCC dose ranged from 8 to 50 IU factor IX/kg. These strategies were based on: bodyweight; bodyweight and initial INR; bodyweight and initial INR and target INR; individual doctors decision; or a fixed dose. Study quality was moderate with large variation in outcome definitions.Relatively good clinical and INR outcomes were reported with the use of any treatment protocol while less good results were reported for INR outcome when a predefined protocol was missing (doctor strategy). Lowest PCC dosages were infused in the fixed dose strategy.In emergency VKA reversal, a predefined PCC dosing protocol seems essential. We found no evidence that one dosing strategy is superior. Future studies should be designed to investigate if body weight and INR are relevant for PCC dosing. In these, we need uniform outcome definitions. (C) 2014 Elsevier Ltd. All rights reserved.

KW - Hematology (hemostasis and thrombosis)

KW - oral anticoagulants

KW - Vitamin-K dependent coagulation proteins

KW - prothrombin complex concentrates

KW - ORAL ANTICOAGULANT-THERAPY

KW - EMERGENCY REVERSAL

KW - WARFARIN REVERSAL

KW - INTRACRANIAL HEMORRHAGE

KW - RAPID REVERSAL

KW - SAFETY

KW - EFFICACY

KW - METAANALYSIS

KW - FRENCH

KW - TRIAL

U2 - 10.1016/j.thromres.2014.11.019

DO - 10.1016/j.thromres.2014.11.019

M3 - Review article

VL - 135

SP - 9

EP - 19

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

IS - 1

ER -

ID: 22560995