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Warfarin, a widely utilized anticoagulant, is paramount for preventing thromboembolic events in patients with mechanical heart valve replacements. However, its narrow therapeutic index can lead to over-anticoagulation and overdose, resulting in serious health risks. This study examines the efficacy of human prothrombin complex concentrate (PCC) in managing warfarin overdose, in comparison with traditional treatments. A retrospective analysis was conducted on 162 adults who presented with warfarin overdose (INR > 5.0) at a tertiary care hospital between 2016 and 2020. Participants were divided into 2 groups-those treated with PCC (n = 57) and those treated with conventional methods (n = 105), including vitamin K and fresh frozen plasma. The primary outcome was the rate of reaching the target (International Normalized Ratio) INR within 24 hours. Secondary outcomes included transfusion requirements, thromboembolic events, adverse reactions, 30-day mortality, and length of hospital stay. PCC demonstrated significant efficacy, with 89.5% of patients achieving the target INR within 24 hours, compared to 64.8% in the control group (P < .05). The PCC group also had reduced transfusion requirements and a shorter average hospital stay. There was no significant difference in thromboembolic events or adverse reactions between the 2 groups, and the reduced 30-day mortality in the PCC group was not statistically significant. Human prothrombin complex concentrate is associated with rapid reaching the target INR, decreased transfusion needs, and shortened hospitalization, making it a promising option for warfarin overdose management. While the results are encouraging, larger, multicenter, randomized controlled trials are necessary to further validate these findings and optimize PCC administration protocols.

Competing Interests: The authors have no funding and conflicts of interest to disclose.

Titel:	Efficacy of human prothrombin complex concentrate in the treatment of warfarin overdose in patients receiving warfarin for mechanical heart valve replacement.
Autor/in / Beteiligte Person:	Uncu, H ; Badak, TO ; Ucak, HA ; Cereb, F ; Cakallioglu, A
Link:	Zum Volltext
Zeitschrift:	Medicine, Jg. 103 (2024-05-10), Heft 19, S. e38022
Veröffentlichung:	Hagerstown, Md : Lippincott Williams & Wilkins, 2024
Medientyp:	academicJournal
ISSN:	1536-5964 (electronic)
DOI:	10.1097/MD.0000000000038022
Schlagwort:	Humans Female Male Retrospective Studies Middle Aged Aged Heart Valve Prosthesis Implantation adverse effects Heart Valve Prosthesis Implantation methods Thromboembolism prevention & control Adult Treatment Outcome Blood Transfusion statistics & numerical data Length of Stay statistics & numerical data Vitamin K therapeutic use Warfarin adverse effects Warfarin therapeutic use Blood Coagulation Factors therapeutic use Blood Coagulation Factors administration & dosage Anticoagulants adverse effects Anticoagulants therapeutic use International Normalized Ratio Drug Overdose drug therapy Drug Overdose therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Medicine (Baltimore)] 2024 May 10; Vol. 103 (19), pp. e38022. MeSH Terms: Warfarin* / adverse effects ; Warfarin* / therapeutic use ; Blood Coagulation Factors* / therapeutic use ; Blood Coagulation Factors* / administration & dosage ; Anticoagulants* / adverse effects ; Anticoagulants* / therapeutic use ; International Normalized Ratio* ; Drug Overdose* / drug therapy ; Drug Overdose* / therapy ; Humans ; Female ; Male ; Retrospective Studies ; Middle Aged ; Aged ; Heart Valve Prosthesis Implantation / adverse effects ; Heart Valve Prosthesis Implantation / methods ; Thromboembolism / prevention & control ; Adult ; Treatment Outcome ; Blood Transfusion / statistics & numerical data ; Length of Stay / statistics & numerical data ; Vitamin K / therapeutic use References: Circulation. 2013 Sep 10;128(11):1234-43. (PMID: 23935011) ; Am J Cardiol. 2020 Apr 1;125(7):1102-1107. (PMID: 31964500) ; Anesthesiology. 2015 Feb;122(2):241-75. (PMID: 25545654) ; Br J Haematol. 2009 Apr;145(1):24-33. (PMID: 19222477) ; Dtsch Arztebl Int. 2018 Nov 16;115(46):776-783. (PMID: 30602410) ; Arch Intern Med. 2007 Jul 9;167(13):1414-9. (PMID: 17620536) ; Cardiovasc Drugs Ther. 2022 Aug;36(4):749-761. (PMID: 33428092) ; N Engl J Med. 2011 Nov 24;365(21):2002-12. (PMID: 22111719) ; Chest. 2008 Jun;133(6 Suppl):160S-198S. (PMID: 18574265) ; Thromb Res. 2014 May;133(5):705-13. (PMID: 24666649) ; Drug Chem Toxicol. 2022 Jul;45(4):1732-1738. (PMID: 33494629) ; Lancet. 2015 May 23;385(9982):2077-87. (PMID: 25728933) ; Cochrane Database Syst Rev. 2015 Jul 07;(7):CD010555. (PMID: 26151108) Substance Nomenclature: 5Q7ZVV76EI (Warfarin) ; 0 (Blood Coagulation Factors) ; 37224-63-8 (prothrombin complex concentrates) ; 0 (Anticoagulants) ; 12001-79-5 (Vitamin K) Entry Date(s): Date Created: 20240510 Date Completed: 20240510 Latest Revision: 20240512 Update Code: 20240512 PubMed Central ID: PMC11081568

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Efficacy of human prothrombin complex concentrate in the treatment of warfarin overdose in patients receiving warfarin for mechanical heart valve replacement.