Risk of Venous Thromboembolism after Receiving Prothrombin Complex Concentrate for Warfarin-associated Intracranial Hemorrhage

Diana Felton, Elizabeth M. Foley, Stephen Traub, Alina Vodonos, Michael Ganetsky

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10 Scopus citations

Abstract

Background Prothrombin complex concentrates (PCCs) are commonly used to rapidly reverse warfarin-associated coagulopathy; however, venous thromboembolism (VTE) is an established adverse event. Objective To determine risk factors for VTE AFTER administration of a three-factor prothrombin complex concentrate (3F-PCC) for warfarin-associated intracranial hemorrhage (ICH). Methods Retrospective chart review of all patients with a warfarin-associated ICH who received a 3F-PCC at a single tertiary care hospital between 2008 and 2013. Outcomes were VTE events (defined as deep vein thrombosis [DVT], pulmonary embolism [PE], limb ischemia, transient ischemic attack, cerebrovascular accident, non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction, and unexplained sudden death) occurring within 30 days of 3F-PCC administration. Risk factors in subjects with and without VTE complications were compared via Fisher's exact test, Student's t-test, Mann-Whitney U test, and univariate logistic regression as appropriate. Results Two hundred nine subjects received 3F-PCC for warfarin-associated ICH. There were 22 VTE events in 19 subjects (9.1%). Baseline characteristics of subjects with and without VTE were similar. There was a significant increase in VTE events in 29 subjects who were taking warfarin for a previous PE or DVT (36.8% vs. 11.6%, p = 0.007; logistic regression odds ratio 4.455, p = 0.005). Conclusions Patients with a prior history of PE or DVT who were given 3F-PCC for warfarin-associated ICH were 4.5 times more likely to sustain a VTE within 30 days. A careful analysis of risks and benefits of rapidly reversing anticoagulation must be made prior to the administration of 3F-PCC in this patient population.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Emergency Medicine
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2016

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Keywords

  • intracranial hemorrhage
  • PCC
  • Profilnine
  • venous thromboembolism
  • warfarin

ASJC Scopus subject areas

  • Emergency Medicine

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