ICJEM
Intercontinental Journal of Emergency Medicine

The Intercontinental Journal of Emergency Medicine aims to publish issues related to all fields of emergency medicine and all specialties involved in the management of emergencies in the hospital and prehospital environment of the highest scientific and clinical value at an international level and accepts articles on these topics. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

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Original Article
Evaluation of the use and efficacy of prothrombin complex concentrates in patients presenting to the emergency department with warfarin
Abstract
Aims: Warfarin administration has been a standard treatment for preventing thromboembolism in patients with atrial fibrillation prosthetic heart valves for many years. It is one of the leading drugs implicated in emergency room visits for adverse drug reactions. Because of a narrow therapeutic window, as many as 3% to 7% of patients taking warfarin are at risk of significant, life-threatening bleeding, and it is generally considered that this requires rapid and complete warfarin reversal. Although there are treatments such as vitamin K and fresh frozen plasma to reverse the effects of warfarin, the most effective method involves using prothrombin complex concentrates (PCC). This study aims to evaluate the use and efficacy of PCC in patients with warfarin-induced bleeding in the emergency department.
Methods: The patients receiving PCC for warfarin reversal in the emergency department between January 1, 2019 – April 1, 2021, were identified from the hospital's electronic database. Demographic data, reasons for warfarin use, PCC indications, INR values before and after PCC, and mortality of the patients were evaluated. The four-factor PCC dose was determined according to the patient's body weight, admission INR level, and target INR level. The study was conducted with 73 patients.
Results: The mean age of the patients was 69.3 ± 15.5 years. The female/male ratio was 1/1.5. The most common PCC indications were gastrointestinal bleeding (32.9%), urogenital bleeding (23.3%), epistaxis (12.3%), and urgent surgical need (12.3%), respectively. The median international normalized ratio (INR) before and after treatment with PCC was 9.2 (min-max 2.1-11.8) and 1.8 (min-max 1.0-4.6). The mean dose of PCC was 1500 IU (min-max 750-3250 IU). In addition to PCC, all patients received vitamin K; 17.8% received erythrocyte suspension, and 10.9% received fresh frozen plasma. There were no PCC-related complications in the emergency department. While 38.4% of the patients consulted the inpatient services after the emergency department, 5.5% were referred to an external center, and 56.2% were discharged from the emergency department after successful treatment. 26% of the patients were followed in the intensive care unit. No patient died in the emergency department. However, in-hospital mortality was 5.5%.
Conclusion: Four-factor PCC is an effective and safe treatment for reversing warfarin-associated bleeding.

Keywords : Warfarin-associated bleeding, prothrombin complex concentrates, emergency department

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Article available in :
Volume 2, Issue 2, 2024
Page : 25-30
https://doi.org/10.51271/ICJEM-0032
Article Information
Received : 29 Nov 2023
Accepted : 15 Jan 2024
Published : 13 Jun 2024
Corresponding Author :

Hüseyin Tufan Yanık: Department of Emergency Medicine, Samsun Training and Research Hospital, Samsun, Turkiye

[email protected]
Citation : Yılmaz Y, Güzel M, Yücel M,Yadigaroğlu M, Ocak M, Yanık HT. Evaluation of the use and efficacy of prothrombin complex concentrates in patients presenting to the emergency department with warfarin-induced hemorrhage. Intercont J Emerg Med. 2024;2(2):25-30.

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