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Altered thrombin generation with prothrombin complex concentrate is not detected by viscoelastic testing: an in vitro study.
Br J Anaesth
January 2025
Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria; Department of Anesthesiology and Intensive Care Medicine AUVA Trauma Center Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria.
Background: Bleeding guidelines currently recommend use of viscoelastic testing (VET) to direct haemostatic resuscitation in severe haemorrhage. However, VET-derived parameters of clot initiation, such as clotting time (CT) and activated clotting time (ACT), might not adequately reflect a clinically relevant interaction of procoagulant and anticoagulant activity, as revealed by thrombin generation assays. The aim of this study was to evaluate the ability of CT and ACT to indicate thrombin generation activity.
View Article and Find Full Text PDFThrombin generation after prothrombin complex concentrate or plasma transfusion during cardiac surgery.
J Thromb Thrombolysis
December 2024
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Thrombin generation (TG) is reduced after cardiac surgery using cardiopulmonary bypass (CPB), contributing to coagulopathy and bleeding. Plasma transfusion or four-factor prothrombin complex concentrate (PCC) are commonly used to treat coagulopathic bleeding after CPB without knowledge of how each may restore TG. To determine the effect of PCC infusion on restoration of thrombin generation compared with plasma transfusion, we performed a laboratory-based secondary analysis of a randomized, controlled trial of adult patients undergoing cardiac surgery to assess efficacy and safety of 4 F-PCC versus plasma for treatment of perioperative coagulopathic bleeding after CPB.
View Article and Find Full Text PDFUpdated recommendations for warfarin reversal in the setting of four-factor prothrombin complex concentrate.
Med J Aust
January 2025
Alfred Health, Melbourne, VIC.
Introduction: Warfarin (vitamin K antagonist) remains an established anticoagulant for patients at high risk of arterial and venous thromboembolism. The prompt reversal of the anticoagulant effect of warfarin is necessary in the context of major bleeding or emergency surgery because of its extended inhibition of vitamin K-dependent coagulation factors for days. The mainstay of urgent warfarin reversal has been vitamin K administration, and infusion of a three-factor prothrombin complex concentrate (3FPCC) and the option for the addition of fresh frozen plasma as a source of factor VII.
View Article and Find Full Text PDFCorrespondence on 'Four-factor prothrombin complex concentrate versus andexanet alfa for the reversal of traumatic brain injuries' by Sadek .
Emerg Med J
November 2024
Inpatient Pharmacy, Trinity Health Ann Arbor, Ann Arbor, Michigan, USA.
Correspondence on 'Four-factor prothrombin complex concentrate versus andexanet alfa for the reversal of traumatic brain injuries' by Sadek .
Emerg Med J
November 2024
AstraZeneca, Wilmington, Delaware, USA.
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