Fixed- Versus Variable-Dose Prothrombin Complex Concentrate for the Emergent Reversal of Vitamin K Antagonists: A Systematic Review and Meta-Analysis
Authors' conclusion
A fixed-dose regimen for 4-PCC administration provides benefits over a variable-dose regimen in terms of dose reduction, faster administration time, improved clinical hemostasis, and reduced mortality and thromboembolic events.
Study context
- Population
- Patients needing emergent reversal of vitamin K antagonists (eg warfarin); extracranial bleeding predominant indication3 RCTs, n = 323
- Comparison
- Fixed- vs variable-dose four-factor PCC
Methodological detailsindependent duplicate screening and extraction, subgroup analyses
- Independent duplicate screening and extraction
- Subgroup analyses
Pooled result
As reported in the abstract
- Fixed dose may be associated with a lower 4-PCC dose vs variable dose
- Fixed dose reduces 4-PCC administration time vs variable dose
- Fixed dose likely increases clinical hemostasis
- No clear difference in achieving goal international normalized ratio (INR) <2
- Fixed dose less likely to achieve goal INR <1.5
- Fixed dose reduces mortality
- High certainty evidence for mortality
Safety
- Fixed dose reduces thromboembolic events
- High certainty evidence
Original publication
Fixed- Versus Variable-Dose Prothrombin Complex Concentrate for the Emergent Reversal of Vitamin K Antagonists: A Systematic Review and Meta-Analysis. Crit Care Med. Published 14 February 2024. doi:10.
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