Management of direct factor Xa inhibitor-related major bleeding with prothrombin complex concentrate: a meta-analysis.
Journal
Blood advances
ISSN: 2473-9537
Titre abrégé: Blood Adv
Pays: United States
ID NLM: 101698425
Informations de publication
Date de publication:
22 01 2019
22 01 2019
Historique:
received:
27
07
2018
accepted:
03
11
2018
entrez:
20
1
2019
pubmed:
20
1
2019
medline:
10
1
2020
Statut:
ppublish
Résumé
A targeted antidote for reversal of direct factor Xa (FXa) inhibitors is now available for clinical use in the United States, but it is costly and has limited availability. In a systematic review, we evaluated the safety and effectiveness of 4-factor prothrombin complex concentrate (4F-PCC) as an alternative for managing direct FXa inhibitor-related major bleeding. A systematic literature search was conducted using Medline, Embase, and the Cochrane Register of Controlled Trials up to September 2018. No comparative studies were found. Ten case series with 340 patients who received PCC for direct FXa inhibitor-related major bleeding were included. The pooled proportion of patients with effective management of major bleeding was 0.69 (95% confidence interval [CI], 0.61-0.76) in 2 studies using the International Society on Thrombosis and Haemostasis (ISTH) criteria and 0.77 (95% CI, 0.63-0.92) in 8 studies that did not use the ISTH criteria; all-cause mortality was 0.16 (95% CI, 0.07-0.26), and thromboembolism rate was 0.04 (95% CI, 0.01-0.08). On the basis of evidence with very low certainty from single-arm case series, it is difficult to determine whether 4F-PCC in addition to cessation of direct oral FXa inhibitor is more effective than cessation of direct oral FXa inhibitor alone in patients with direct FXa inhibitor-related major bleeding.
Identifiants
pubmed: 30658963
pii: bloodadvances.2018024133
doi: 10.1182/bloodadvances.2018024133
pmc: PMC6341194
doi:
Substances chimiques
Blood Coagulation Factors
0
Factor Xa Inhibitors
0
prothrombin complex concentrates
37224-63-8
Types de publication
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
158-167Informations de copyright
© 2019 by The American Society of Hematology.
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