Benefits and harms of 4-factor prothrombin complex concentrate for reversal of vitamin K antagonist associated bleeding: a systematic review and meta-analysis
被引:46
作者:
Brekelmans, Marjolein P. A.
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机构:
Acad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, NetherlandsAcad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
Brekelmans, Marjolein P. A.
[1
]
van Ginkel, Kim
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机构:
Univ Amsterdam, Amsterdam, NetherlandsAcad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
van Ginkel, Kim
[2
]
Daams, Joost G.
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机构:
Acad Med Ctr, Med Lib, Amsterdam, NetherlandsAcad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
Daams, Joost G.
[3
]
Hutten, Barbara A.
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机构:
Acad Med Ctr, Dept Clin Epidemiol, Amsterdam, NetherlandsAcad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
Hutten, Barbara A.
[4
]
Middeldorp, Saskia
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机构:
Acad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, NetherlandsAcad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
Middeldorp, Saskia
[1
]
Coppens, Michiel
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机构:
Acad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, NetherlandsAcad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
Coppens, Michiel
[1
]
机构:
[1] Acad Med Ctr, Dept Vasc Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
[2] Univ Amsterdam, Amsterdam, Netherlands
[3] Acad Med Ctr, Med Lib, Amsterdam, Netherlands
[4] Acad Med Ctr, Dept Clin Epidemiol, Amsterdam, Netherlands
Prothrombin complex concentrate (PCC) is used for reversal of vitamin K antagonists (VKA) in patients with bleeding complications. This study aims to assess benefits and harms of 4-factor PCC compared to fresh frozen plasma (FFP) or no treatment in VKA associated bleeding. PubMed, EMBASE and CENTRAL were searched from 1945 to August 2015. Studies reporting 4-factor PCC use for VKA associated bleeding and providing data on INR normalization, mortality or thromboembolic (TE) complications were eligible. Two authors screened titles and full articles for inclusion, extracted data, and assessed risk of bias. Mortality data were pooled using Mantel-Haenszel random effects meta-analysis. Nineteen studies were included (N = 2878); 18 cohort studies and one RCT. Six studies had good methodological quality, 9 moderate and 4 poor. Baseline INR values ranged from 2.2 to > 20. The INR within 1 h after PCC administration ranged from 1.4 to 1.9, and after FFP administration from 2.2 to 12. PCC reduced the time to reach INR correction in comparison with FFP or no treatment. The observed mortality rate ranged from 0 to 43% (mean 17%) in the PCC, 4.8-54% (mean 16%) in the FFP and 23-69% (mean 51%) in the no treatment group. Meta-analysis of mortality data resulted in an OR of 0.64 (95% confidence interval [CI] 0.27-1.5) for PCC versus FFP and an OR 0.41 (95% CI 0.13-1.3) for PCC versus no treatment. TE complications were observed in 0-18% (mean 2.5%) of PCC and in 6.4% of FFP recipients. Four-factor PCC is an effective and safe option in reversal of VKA bleeding events.
机构:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TNDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Bechtel B.F.
Nunez T.C.
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h-index: 0
机构:
Eskind Biomedical Library, Vanderbilt University School of Medicine, Nashville, TNDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Nunez T.C.
Lyon J.A.
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h-index: 0
机构:
Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TXDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Lyon J.A.
Cotton B.A.
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h-index: 0
机构:
Department of Surgery, Center for Translational Injury Research, University of Texas Medical School, Houston, TXDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Cotton B.A.
Barrett T.W.
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h-index: 0
机构:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TNDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
机构:
McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, CanadaMcMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Crowther, Mark A.
Ageno, Walter
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Ageno, Walter
Garcia, David
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Garcia, David
Wang, Luqi
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Wang, Luqi
Witt, Dan M.
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Witt, Dan M.
Clark, Nathan P.
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Clark, Nathan P.
Blostein, Mark D.
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Blostein, Mark D.
Kahn, Susan R.
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Kahn, Susan R.
Vesely, Sara K.
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Vesely, Sara K.
Schulman, Sam
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Schulman, Sam
Kovacs, Michael J.
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Kovacs, Michael J.
Rodger, Marc A.
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Rodger, Marc A.
Wells, Phillip
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Wells, Phillip
Anderson, David
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Anderson, David
Ginsberg, Jeffery
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Ginsberg, Jeffery
Selby, Rita
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Selby, Rita
Siragusa, Sergio
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Siragusa, Sergio
Silingardi, Mauro
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Silingardi, Mauro
Dowd, Mary Beth
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Dowd, Mary Beth
Kearon, Clive
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
机构:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TNDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Bechtel B.F.
Nunez T.C.
论文数: 0引用数: 0
h-index: 0
机构:
Eskind Biomedical Library, Vanderbilt University School of Medicine, Nashville, TNDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Nunez T.C.
Lyon J.A.
论文数: 0引用数: 0
h-index: 0
机构:
Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TXDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Lyon J.A.
Cotton B.A.
论文数: 0引用数: 0
h-index: 0
机构:
Department of Surgery, Center for Translational Injury Research, University of Texas Medical School, Houston, TXDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Cotton B.A.
Barrett T.W.
论文数: 0引用数: 0
h-index: 0
机构:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TNDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
机构:
McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, CanadaMcMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Crowther, Mark A.
Ageno, Walter
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Ageno, Walter
Garcia, David
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Garcia, David
Wang, Luqi
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h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Wang, Luqi
Witt, Dan M.
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Witt, Dan M.
Clark, Nathan P.
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Clark, Nathan P.
Blostein, Mark D.
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Blostein, Mark D.
Kahn, Susan R.
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Kahn, Susan R.
Vesely, Sara K.
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Vesely, Sara K.
Schulman, Sam
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Schulman, Sam
Kovacs, Michael J.
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Kovacs, Michael J.
Rodger, Marc A.
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Rodger, Marc A.
Wells, Phillip
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Wells, Phillip
Anderson, David
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Anderson, David
Ginsberg, Jeffery
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Ginsberg, Jeffery
Selby, Rita
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Selby, Rita
Siragusa, Sergio
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Siragusa, Sergio
Silingardi, Mauro
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Silingardi, Mauro
Dowd, Mary Beth
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada
Dowd, Mary Beth
Kearon, Clive
论文数: 0引用数: 0
h-index: 0
机构:McMaster Univ, St Josephs Hosp, Fac Hlth Sci, Div Hematol & Thromboembolism, Hamilton, ON L8N 4A6, Canada