4-factor prothrombin complex concentrate may be the best choice for patients taking warfarin who develop severe bleeding, according to a study involving 299 individuals.

Investigators reviewed the medical records of participants, two-thirds of whom were on warfarin prior to admission. They looked at mortality, length of stay, change in international normalized ratio (INR), plasma use, and number of thromboembolic complications.

In patients taking warfarin:

• Those receiving recombinant activated factor VII and 3-factor prothrombin complex concentrate combination had the greatest INR decrease, and the lowest overall INR; however, they also had more clotting complications.

• Recombinant activated factor VII alone used the most plasma.

In those not on warfarin, patients taking the combination had the shortest length of stay among survivors, but those receiving recombinant activated factor VII had the lowest mortality.

The authors concluded that even though it was only recently introduced, 4-factor prothrombin complex concentrate may be the preferred choice.

Citation: DeLoughery E, Avery B, DeLoughery T. Retrospective study of rFVIIa, 4-factor PCC, and a rFVIIa and 3-factor PCC combination in improving bleeding outcomes in the warfarin and non-warfarin patient. [Published online ahead of print May 11, 2016]. Am J Hematol. doi:10.1002/ajh.24384.