E-ISSN: 2148-4570 • ISSN:2148-4570
Use of Prothrombin Complex Concentrate in the Emergency Department for Cases With Warfarin Overdose: A Retrospective Study [Ankara Med J]
Ankara Med J. 2020; 20(4): 1071-1081 | DOI: 10.5505/amj.2020.82085

Use of Prothrombin Complex Concentrate in the Emergency Department for Cases With Warfarin Overdose: A Retrospective Study

Filiz Baloglu Kaya1, Engin Ozakin1, Gizem Coşkun Yüksel1, Muhammed Evvah Karakilic1, Seyhmus Kaya2, Mustafa Emin Canakci1
1Eskisehir Osmangazi University Faculty Of Medicine And Health Science, Department Of Emergency Medicine, Eskisehir.
2Eskisehir City Hospital Department Of Emergency Medicine

INTRODUCTION: The aim of the study is to evaluate the cases with warfarin therapy in which elevated International Normalized Ratio (INR) was detected and Prothrombin Complex Concentrate (PCC) was used for treatment at the Emergency Department (ED), and their treatment outcomes.
METHODS: The study was conducted retrospectively at the ED of Eskisehir Osmangazi University Medical School between 01.01.2013-31.07.2019. Patients 18 years and older having Warfarin therapy who had elevated INR and PCC indication at the ED were included in the study. Demographics, INR levels, and their relationship with mortality were evaluated. The target INR was set as 1.5. The study was conducted retrospectively at the ED of Eskisehir Osmangazi University Medical School between 01.01.2013-31.07.2019. Patients 18 years and older having Warfarin therapy who had elevated INR and PCC indication at the ED were included in the study. Demographics, INR levels, and their relationship with mortality were evaluated. The target INR was set as 1.5. The study was conducted retrospectively at the ED of Eskisehir Osmangazi University Medical School between 01.01.2013-31.07.2019. Patients 18 years and older having Warfarin therapy who had elevated INR and PCC indication at the ED were included in the study. Demographics, INR levels, and their relationship with mortality were evaluated. The target INR was set as 1.5.
RESULTS: The average age in 106 evaluated cases was 71 (range, 28-97) and 59 (55.70%) were female. The most common reason for warfarin use was atrial fibrillation (42 cases-39.60%). The most common reason for PCC use was intracranial hemorrhage (48 cases-45.30%). The initial median INR was 8.96 (Q1-Q3: 5.06-15). There was no statistically significant relation between initial INR and the reasons for PCC use (p=0.93). The control median INR was 1.43 (Q1-Q3: 1.26-1.91). Target INR was achieved in 49 cases (49.00%). The median drop levels in INR was 81(Q1-Q3: 67-89). 24-hour mortality was 1.97% and 30-day mortality was 20.7%. There was no statistically significant relation between initial INR and mortality (p=0.06-0.09, respectively). No thromboembolic incident was encountered.
DISCUSSION AND CONCLUSION: In patients, who have hemorrhage or hemorrhage risk due to warfarin overdose, treatment should be implemented considering hemorrhage. In life-threatening hemorrhages and emergency interventions related to warfarin, PCC has an efficient role in INR reduction.

Keywords: Anticoagulant, hemorrhage, prothrombin complex concentrate.

Varfarin Doz Aşımı Olan Olgular İçin Acil Serviste Protrombin Kompleks Konsantresi Kullanımı: Geriye Dönük Çalışma

Filiz Baloglu Kaya1, Engin Ozakin1, Gizem Coşkun Yüksel1, Muhammed Evvah Karakilic1, Seyhmus Kaya2, Mustafa Emin Canakci1
1Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Eskişehir.
2Eskişehir Şehir Hastanesi Acil Tıp Kliniği

GİRİŞ ve AMAÇ: Çalışmanın amacı varfarin tedavisi alırken acil serviste (AS) International Normalized Ratio (INR) yüksekliği tespit edilen ve tedavide Protrombin Kompleks Konsantresi (PCC) kullanılan olguları uygulama sonuçları ile birlikte değerlendirmektir.
YÖNTEM ve GEREÇLER: Çalışma 01.01.2013-31.07.2019 arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Hastanesi Acil Servis’inde geriye dönük olarak yapıldı. Varfarin tedavisi alırken AS’de INR yüksekliği saptanan, PCC uygulama endikasyonu olan 18 yaş ve üstü hastalar çalışmaya dahil edildi. Demografik veriler, INR değerleri ve bunların mortalite ile ilişkileri değerlendirildi. Hedef INR değeri 1,5 olarak belirlendi.
BULGULAR: Değerlendirmeye alınan 106 olgunun yaş ortalaması 71 (28-97 aralığında) ve 59’u (%55,70) kadındı. Varfarin kullanım nedeni 42 (%39,60) olgu ile en sık atriyal fibrilasyondu. En sık PCC kullanım nedeni ise 48 (%45,30) olgu ile intrakraniyal kanama idi. Başvuru INR ortanca değeri 8,96 (Q-Q3: 5,06-15) idi. Başvuru INR değerleri ile PCC kullanma nedenleri arasında istatistiksel anlamlı ilişki saptanmadı (p= 0,93). PCC uygulaması sonrası kontrol INR ortanca değeri 1,43 (Q1-Q3: 1,26-1,91) bulundu. Olguların 49’unda (%46,00) hedef INR’ye ulaşıldığı görüldü. Olguların INR azalma oranlarının ortanca değeri 81 (Q1-Q3: 67-89) olarak belirlendi. 24 saatlik mortalite %1,97 iken 30 günlük mortalite %20,7 olarak saptandı. Başvuru ve kontrol INR değerleri ile mortalite arasında istatistiksel ilişki saptanmadı (p değerleri sırasıyla; 0,06-0,09). Tromboembolik olaya rastlanmadı.
TARTIŞMA ve SONUÇ: Varfarin doz aşımına bağlı kanaması veya kanama riski olan hastalarda kanamanın ciddiyeti dikkate alınarak tedavi verilmelidir. Varfarin kullanımına bağlı hayatı tehdit eden kanamalarda ve acil girişimlerde PCC kullanımı INR azalmasında etkin rol oynamaktadır.

Anahtar Kelimeler: Antikoagülan, kanama, protrombin kompleks konsantresi.

Filiz Baloglu Kaya, Engin Ozakin, Gizem Coşkun Yüksel, Muhammed Evvah Karakilic, Seyhmus Kaya, Mustafa Emin Canakci. Use of Prothrombin Complex Concentrate in the Emergency Department for Cases With Warfarin Overdose: A Retrospective Study. Ankara Med J. 2020; 20(4): 1071-1081

Corresponding Author: Filiz Baloglu Kaya, Türkiye
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