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

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.

Varfarin Doz Aþýmý Olan Olgular Ýçin Acil Serviste Protrombin Kompleks Konsantresi Kullanýmý: Geriye Dönük Çalýþma

GÝRÝÞ ve AMAÇ: Çalýþmanýn amacý varfarin tedavisi alýrken acil serviste (AS) International Normalized Ratio (INR) yüksekliði tespit edilen ve tedavide Protrombin Kompleks Konsantresi (PCC) kullanýlan olgularý uygulama sonuçlarý ile birlikte deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþma 01.01.2013-31.07.2019 arasýnda Eskiþehir Osmangazi Üniversitesi Týp Fakültesi Hastanesi Acil Servis’inde geriye dönük olarak yapýldý. Varfarin tedavisi alýrken AS’de INR yüksekliði saptanan, PCC uygulama endikasyonu olan 18 yaþ ve üstü hastalar çalýþmaya dahil edildi. Demografik veriler, INR deðerleri ve bunlarýn mortalite ile iliþkileri deðerlendirildi. Hedef INR deðeri 1,5 olarak belirlendi.
BULGULAR: Deðerlendirmeye alýnan 106 olgunun yaþ ortalamasý 71 (28-97 aralýðýnda) ve 59’u (%55,70) kadýndý. Varfarin kullaným nedeni 42 (%39,60) olgu ile en sýk atriyal fibrilasyondu. En sýk PCC kullaným nedeni ise 48 (%45,30) olgu ile intrakraniyal kanama idi. Baþvuru INR ortanca deðeri 8,96 (Q-Q3: 5,06-15) idi. Baþvuru INR deðerleri ile PCC kullanma nedenleri arasýnda istatistiksel anlamlý iliþki saptanmadý (p= 0,93). PCC uygulamasý sonrasý kontrol INR ortanca deðeri 1,43 (Q1-Q3: 1,26-1,91) bulundu. Olgularýn 49’unda (%46,00) hedef INR’ye ulaþýldýðý görüldü. Olgularýn INR azalma oranlarýnýn ortanca deðeri 81 (Q1-Q3: 67-89) olarak belirlendi. 24 saatlik mortalite %1,97 iken 30 günlük mortalite %20,7 olarak saptandý. Baþvuru ve kontrol INR deðerleri ile mortalite arasýnda istatistiksel iliþki saptanmadý (p deðerleri sýrasýyla; 0,06-0,09). Tromboembolik olaya rastlanmadý.
TARTIÞMA ve SONUÇ: Varfarin doz aþýmýna baðlý kanamasý veya kanama riski olan hastalarda kanamanýn ciddiyeti dikkate alýnarak tedavi verilmelidir. Varfarin kullanýmýna baðlý hayatý tehdit eden kanamalarda ve acil giriþimlerde PCC kullanýmý INR azalmasýnda etkin rol oynamaktadýr.