Author(s)

Alexandre de Matos Soeiro^*, Maria Cristina César, Bruno Biselli, Aline Siqueira Bossa, T. de Carvalho Andreucci Torres Leal, Maria Carolina Feres de Almeida Soeiro, Carlos V. Serrano, Ludhmila Abraão Hajjar, Múcio Tavares Oliveira

Emergency Unit–Heart Institute–University of São Paulo Medical School, São Paulo, Brazil.

Objective: The objective of this study was to analyse the reversibility of the anticoagulant effect of warfarin by comparing prothrombin complex concentrate (PCC) versus frozen fresh plasma (FFP) in cardiology patients with serious warfarin intoxication. Methods: This was an observational and retrospective study comprising 67 patients (18 in group I [PCC] and 49 in group II [FFP]). The primary endpoint was the reversal of anticoagulant effect of warfarin after 2 and 24 hours of PCC or FFP administration. Comparisons between the groups were made using T-test and Q-square. Multivariate analyses were conducted using logistic regression, and the results were considered significant when p < 0.05. Complementary analysis was performed using the ROC curve, calculating the area under the curve (AUC), and calculating the cut-off score for the relation between PCC (UI/kg) or FFP (ml/kg) and INR reversibility. Results: The medium dose used was 27.6 UI/kg of PCC and 14.5 ml/kg of FFP. Significant differences were observed between groups I and II in the INR reversibility measurements after 2 hours (33.3% vs. 6.1%, p = 0.001) and 24 hours (38.9% vs. 12.2%, p = 0.009) as well as in the occurrence of pulmonary edema (5.6% vs. 42.9%, OR = 11.10, p = 0.04). The AUC for PCC was 0.891 (CI 95% [0.72 - 1.0]), and for FFP, it was 0.291 (CI 95% [0.09 - 0.49]). Conclusions: PCC is better than FFP treatment in reversing the warfarin intoxication after 2 and 24 hours of administration. Furthermore, PCC showed lower pulmonary edema in cardiology patients.

Intoxication, Warfarin, Fresh Frozen Plasma, Prothrombin Complex Concentrate

de Matos Soeiro, A. , César, M. , Biselli, B. , Bossa, A. , de Carvalho Andreucci Torres Leal, T. , de Almeida Soeiro, M. , Serrano, C. , Hajjar, L. and Oliveira, M. (2017) Superiority of Prothrombin Complex Concentrate versus Frozen Fresh Plasma in Cardiology Patients with Warfarin Intoxication–Observational Study. Open Journal of Emergency Medicine, 5, 75-84. doi: 10.4236/ojem.2017.52007.