Grace Cooksey, BCCCP, PharmD
Wake Forest Baptist Health
Winston Salem, North Carolina
Disclosure information not submitted.
Shaun Rowe, PharmD, MS, BCCCP, FNCS
Associate Professor
University of Tennessee College of Pharmacy, United States
Disclosure information not submitted.
Leslie Hamilton, BCCCP, BCPS, PharmD
Associate Professor
University of Tennessee College of Pharmacy
Knoxville, Tennessee
Disclosure information not submitted.
James McMillen, PharmD, MBA, BCPS, BCCCP
Pharmacist
University of Tennessee Medical Center, United States
Disclosure information not submitted.
Jared Griffard, MD
Resident Physician
University of Tennessee Medical Center, United States
Disclosure information not submitted.
Title: Impact of DOAC Reversal with Activated Prothrombin Complex Concentrate in Traumatic Brain Injuries
Introduction:
Anticoagulant use prior to trauma has been associated with increased incidence of traumatic brain injury (TBI), intracranial hemorrhage (ICH) progression, and mortality. Prothrombin complex concentrates (PCC) are commonly used as off-label treatments for direct oral anticoagulant (DOAC) associated life-threatening hemorrhage. At this time, there is no consensus regarding appropriate indication, target dose, or outcomes of PCC administration for/ DOAC reversal in patients presenting with traumatic ICH.
Methods:
This single-center retrospective cohort study included patients ≥ 18 years presenting with an acute TBI of any severity on apixaban or rivaroxaban from 9/1/2016 to 9/1/2019. Exclusion criteria included spontaneous ICH or coagulopathy. Propensity score matching was conducted with the following variables: age, Abbreviate Injury Scale (AIS) head, and Charlson Comorbidity Index score. The primary outcome was hemorrhage stability within 48 hours. Secondary outcomes included degree of hemorrhage progression, in-hospital mortality, discharge disposition, and incidence of thromboembolic events.
Results:
Of the 115 patients who met inclusion criteria, 84 were included in the propensity score matched dataset. Baseline characteristics, comorbidities, and TBI severity were similar between groups. In the reversal group, the average PCC dose administered was 34.3 units/kg aPCC, 30.5 units/kg 4F-PCC, or 54.9 units/kg 4F-PCC and aPCC. There were no differences observed in the incidence of hemorrhage progression (10.8% No Reversal (NR) vs. 15.0% Reversal (R); p=0.739) or the median change in ICH volume (0 mL NR vs. 1 mL R; p=0.2199) between groups. Additionally, the use of reversal did not affect in-hospital mortality (3 [7.1%] NR vs. 4 [9.5%] R; p >0.999).
Conclusions:
This study demonstrated that PCC used for the treatment of DOAC-associated ICH related to TBI did not significantly impact the incidence or degree of hemorrhage progression, and PCC treatment did not result in increased thromboembolic events.