PB1310 - Urgent reversal of DOAC anticoagulant effect with Prothrombin Complex Concentrate: Experience in Mexico

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

Juan Pablo Macías-Flores, MD

Hematologist
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social
Querétaro, Queretaro de Arteaga, Mexico

Co-Author(s)

AV

Atenas Villela-Peña

Hematologist
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social
Ciudad de México, Distrito Federal, Mexico
AT

Adriana Tripp-Aguilar

Hematologist
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social
Ciudad de México, Distrito Federal, Mexico
CM

Carolina Moreira-Ponce

Hematologist
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social
Ciudad de México, Estado de México, Mexico
EM

Emmanuel Martínez-Moreno

Hematologist
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social
Ciudad de México, Distrito Federal, Mexico
CT

Claudia Telleria-Arispe

Hematologist
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social
Ciudad de México, Distrito Federal, Mexico

Presenting Author(s)

Abraham Majluf-Cruz, MD, PhD (he/him/his)

Medical chief
Unidad médica de investigación de trombosis, hemostasia y aterogénesis, Instituto Mexicano del Seguro Social
Mexico City, Distrito Federal, Mexico

Background: The increasing use of direct oral anticoagulants (DOACs) and the growing evidence regarding their bleeding complications, highlights the importance of generating accurate information about reversal of their effect.

Aims: To determine the efficacy and safety of prothrombin complex concentrate (PCC) use for the reversal of DOACs anticoagulant effect.

Methods: A single-center, prospective analysis of the efficacy and safety use of PCC in patients requiring reversal of the anticoagulant effect of apixaban, rivaroxaban, or dabigatran in both acute bleeding (Group A) or surgical emergencies (Group B) scenarios. The predefined PCC dose protocol was 30UI/Kg for apixaban/rivaroxaban and 40UI/Kg for dabigatran. An additional dose of PCC was allowed at discretion of the treating physician. Major bleeding definition and effectiveness for major bleeding management was performed according to the ISTH criteria.

Results: A total of 114 patients were included; 56 (49.1%) in Group A and 58 (50.9%) in Group B. Venous thromboembolic disease (VTE) was the main DOACs indication (69; 60.5%). For group A, dabigatran was the main DOAC used (32; 57%). Overall, gastrointestinal bleeding was the most frequent complication (19; 33.9%). A total of 42 patients (75%) achieved a successful reversal; failure was documented in 14 patients (25%) (Table 1). For group B, rivaroxaban was the main DOAC indicated (29; 50%). Most patients required abdominal surgery (28; 48.2%). A total of 55 patients (94.8%) had a successful reversal; failure was documented in 3 patients (25; 5.2%) (Table 2).

Conclusion(s): In most patients under treatment with DOACs (including those treated with dabigatran), treatment with PCC offers an effective urgent reversal of the anticoagulant effect (85.1%), with minimal thromboembolic events (14.9%). We suggest that a dose of 30UI/Kg for apixaban and rivaroxaban, and 40UI/Kg for dabigatran reversal. An additional dose may be indicated if necessary.