Episode 43: Put It in Reverse Terry! Fixed-Dosed Kcentra for Vitamin K Antagonist Reversal

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  1. Kcentra (prothrombin complex concentrate [Human]) [package insert]. Kankakee, IL: CSL Behring LLC; 2013.
  2. Tomaselli, Gordon F., et al. “2017 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways.” Journal of the American College of Cardiology 70.24 (2017): 3042-3067.
  3. Schwebach, Alyson A., Ryan A. Waybright, and Thomas J. Johnson. “A Review of Fixed‐Dose Four‐Factor Prothrombin Complex Concentrate for Vitamin K Antagonist Reversal: Does One Dose Fit All?.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy (2019).
  4. Khorsand, Nakisa, et al. “An observational, prospective, two-cohort comparison of a fixed versus variable dosing strategy of prothrombin complex concentrate to counteract vitamin K antagonists in 240 bleeding emergencies.” haematologica 97.10 (2012): 1501-1506.
  5. Abdoellakhan, Rahat Amadkhan, et al. “Fixed versus variable dosing of prothrombin complex concentrate in vitamin K antagonist-related intracranial hemorrhage: a retrospective analysis.” Neurocritical care 26.1 (2017): 64-69.
  6. Klein L, Peters J, Miner J, Gorlin J. Evaluation of fixed dose 4-factor prothrombin complex concentrate for emergent warfarin reversal. Am J Emerg Med. 2015;33(9):1213-1218.
  7. Astrup G, Sarangarm P, Burnett A. Fixed dose 4-factor prothrombin complex concentrate for the emergent reversal of warfarin: a retrospective analysis. J Thromb Thrombolysis. 2018;45(2):300-305.
  8. Dietrich, Mixon, Holowatyj et al. Multi-centered evaluation of a novel fixed-dose four-factor prothrombin complex concentrate protocol for warfarin reversal. Am J Emerg Med. 2020;38(10):2096-2100.
  9. Stoecker, Van Amber, Woster et al. Evaluation of fixed versus variable dosing of 4-factor prothrombin complex concentrate for emergent warfarin reversal. Am J Emerg Med. 2021;48:282-287.
  10. McMahon, Halfpap, Zhao et al. Evaluation of a fixed-dose regimen of 4-factor prothrombin complex concentrate for warfarin reversal. Ann Pharmacother. 2021. [Epub ahead of print]
  11. Elsamadisi P, Cepeda MAG, Yankama T, Wong A, Tran Q, Eche IM. Weight-Based Dosing Versus a Fixed-Dose Regimen of 4-Factor Prothrombin Complex Concentrate in Obese Patients Requiring Vitamin K Antagonist Reversal. Am J Cardiovasc Drugs. 2021 May;21(3):355-361. doi: 10.1007/s40256-020-00442-w. Epub 2020 Nov 5. PMID: 33150496.
  12. Mohammadi, Yaribash, Mohmood, Talasaz. Efficacy and safety of the fixed-dose versus variable-dose of 4-PCC for vitakmin K antagonist reversal: a comprehensive systematic review  and meta-analysis. Cardiovasc Drug Ther. 2021. [Epub ahead of print]
  13. Dietrich SK, Mixon MA, Rech MA. Fixed-dose prothrombin complex concentrate for emergent warfarin reversal among patients with intracranial hemorrhage. Am J Emerg Med. 2021 Jun 26;49:326-330. doi: 10.1016/j.ajem.2021.06.032. Epub ahead of print. PMID: 34224954.


Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

The Pharm So Hard Podcast is a show focused primarily on emergency medicine and hospital pharmacy related topics. To empower healthcare providers with the knowledge and skills they need to provide evidence-based, safe care for critically ill patients.

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