Imunohemoterapia
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Browsing Imunohemoterapia by Subject "Anticoagulants"
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- Human plasma derived prothrombin complex concentrate (OCTAPLEX), the HFF, EPE: Blood Department experience.Publication . Barra, A; Barradas, A; Cardoso, E; Costa, C; Gil, A; Rodrigues, T; Silva, A; Simões, A; Venâncio, BBackground: The HPDPCC was introduced in our clinical practice in 2005, and it has some specific clinical recommendations . We use Octaplex mostly to recert coagulation parameters in patients whose status require their quick conversion, mainly to reverse oral anticoagulation. We initially started using Octaplex in lower doses than the recommended by the drug leaflet, trying to find an optimal dose, aiming to avoid side effects. Aims: Our goals are to share our experience using Octaplex in clinical practice, demonstrating that we can obtain rapid results with minimal dose, without adverse events. Methods: We only included in this study patients who have done Octaplex (1unit – 20ml) and have results of measurement of their International Normalized Ratio (INR) before and after the infusion of prothrombin complex concentrate. The INR was determined using the fully automated hemostasis analyser BCS XP System (Siemens) and the reagent Innovin (Dade Behring). The period of the study was, 2005-2010, and included 87 patients with different diseases. The INR results upper than 10 were counted like 10 because the laboratory doesn’t quantify values higher than this. Results: The patients were 64 men and 23 women, with ages ranged between 18 and 85-years-old, average 66,5-years-old 53 were under treatment with oral anticoagulants (OAC), 22 with liver impairment (1.1), and 12 with other pathologies (OP). The INR before treatment varied from 10 (maximal value) to 1.4 (minimal value), the average values were 6.72 to the patients under OAC, 2.15 to the patients with LI and 3.39 to the patients with OP. After treatment the average values were 2.0 to the OAC 1.84 to the LI and 1.76 to the OP. After treatment the maximal value of the INR was 6.9 and the minimal 0.9. The average number of units used to revert the patients clinical status were for OAC 1.62 (in an average of 1.4 number of intakes), for LI 2 units (1 intake) and for OP 2.75 units (1.42 intakes). We didn’t find any adverse post-administration events. Summary/Conclusions: We found better results in the administration of Octaplex in patients doing OAC, where the 1.62 units (in 1.04 intakes) lowered the INR average from 6.72 to 2.0. The dose used to resolve our clinical cases were much lower than the recommended in the drug leaflet. We didn’t find any adverse events in this dose. The clinical practice feedback suggests a quicker INR conversion comparing to fresh frozen plasma.
- Reverting vitamin k antagonists with prothrombin complex concentrate: a three-year retrospective studyPublication . Plácido, C; Barra, A; Lichtner, A; Cardoso, E; Costa, C; Nunes, CBackground Correcting coagulopathy has been a difficult challenge for hematologists throughout the world. Practice guidelines recommend vitamin K for the reversal of anticoagulation in asymptomatic patients with elevated INR, in patients who require surgery and in patients with serious bleeding. Prothrombin Complex Concentrate (PCC) is having progressive importance in bleeding management and reversal of International Normalized Ratio´s (INR) in patients taking oral vitamin K antagonists (VKA). Aims The main objective of our study is to determine the efficiency of PCC in the correction of INR in patients taking oral VKA and try to understand if the administration of vitamin K plays a role in the survival rates in these patients. Methods We carried out a retrospective, unicenter, descriptive study that included 54 patients taking oral VKA that required Octaplex ® administration in order to try to control bleeding and/or correct INR. Of these patients 55% were female and 45% male. Average age was 76 years old. The data was collected from March 2011 to November 2014. The INR results were collected before and after the treatment with PCC. Results 87% of the studied patients (47 patients) were taking warfarin and 13% (7 patients) acenocoumarol. The main cause of treatment was atrial fibrillation. PCC was administered in 78% due to bleeding and in 22% of the cases to prepare patients for surgery. The mean administered doses were approximately 800IU. Pre-treatment INR determination was 4,4 in the warfarin group and 5,6 in the acenocoumarol group. In 26% of the patients it was not possible to have an absolute INR value (INR>10), 12 patients in the warfarin group (26% of the group) and 1 in the acenocoumarol group (14% of the group). After treatment all patients had a measurable INR and 37% of them had an INR ≤1,5. The INR values dropped to 1,9 in the acenocoumarol group and to 2 in the warfarin group. 18 patients received concomitantly i.v. vitamin K administration. 17 of them 10mg and one 20mg. We compared patients who only received PCC (33 patients) with those that received PCC and vitamin K (14 patients) and the impact on mortality. We excluded patients who did concomitant treatment with plasma (7 patients). We found a mortality of 36% in both groups, but we must point out their non-uniformity. None of the patients enrolled presented reported thrombotic complications. Patients presented different bleeding sites: 23% intracranial (67% mortality), 40% gastrointestinal (38% mortality) and 37% other (33% mortality). The overall mortality was 37%. Bleeding patients presented a mortality of 43% compared with no bleeding that presented mortality of 21%. Summary/Conclusions This study shows that Octaplex® treatment is efficient reversing the INR in patients taking oral VKA. In this population we didn’t find any difference, regarding overall mortality, between patients who had taken vitamin K plus PCC and those who had only taken PCC. We found a higher mortality rate in these bleeding patients.