Observational studyCritical care (London, England)2014
Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study).
Observational study in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 82 citations in OpenAlex.
- Benefits and harms of 4-factor prothrombin complex concentrate for reversal of vitamin K antagonist associated bleeding: a systematic review and meta-analysis.Journal of thrombosis and thrombolysis · 2017Pooled it
- Oral anticoagulant reversal and mortality in trauma patients: a multicentre propensity score-matched cohort study.EClinicalMedicine · 2025Article
- Effectiveness of 4-Factor Prothrombin Complex Concentrate with and without Vitamin K in Managing Warfarin-Associated Major Bleeding.The Eurasian journal of medicine · 2025Article
- Vitamin K Antagonist (Phenprocoumon) and Subarachnoid Hemorrhage: A Single-Center, Matched-Pair Analysis.Neurocritical care · 2020Article
- A Comprehensive Review of Analgesia and Pain Modalities in Hip Fracture Pathogenesis.Current pain and headache reports · 2019Review
- Update in Neurocritical Care: a summary of the 2018 Paris international conference of the French Society of Intensive Care.Annals of intensive care · 2019Review
- Postpartum hemorrhage: Blood product management and massive transfusion.Seminars in perinatology · 2019Review
- Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury.Medical sciences (Basel, Switzerland) · 2019Review
- Optimized clinical practice for superaged patients with hip fracture: significance of damage control and enhanced recovery program.Burns & trauma · 2019Review
- Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department.Scandinavian journal of trauma, resuscitation and emergency medicine · 2018Article
- Comparison of outcomes in patients with intracranial hemorrhage on factor Xa inhibitors versus vitamin K antagonists treated with 4-factor prothrombin complex concentrate.Proceedings (Baylor University. Medical Center) · 2018Article
- Is Coagulopathy an Appropriate Therapeutic Target During Critical Illness Such as Trauma or Sepsis?Shock (Augusta, Ga.) · 2017Review
- Ilio-psoas hematoma in the intensive care unit: a multicentric study.Annals of intensive care · 2016Article
- The critical care management of spontaneous intracranial hemorrhage: a contemporary review.Critical care (London, England) · 2016Review
- 3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Severe Bleeding: A Multicenter, Retrospective, Propensity-Matched Pilot Study.Journal of thrombosis and thrombolysis · 2016Article
- Polytrauma in the elderly: a review.EFORT open reviews · 2016Article
- Spotlight on idarucizumab and its potential for the reversal of anticoagulant effects of dabigatran.Drug design, development and therapy · 2016Review
- Reversal of anticoagulant effects in patients with intracerebral hemorrhage.Current neurology and neuroscience reports · 2015Review
Corrections and comments
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Authors and funding
7 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn vitamin K antagonist (VKA)-treated patients with severe hemorrhage, guidelines recommend prompt VKA reversal with prothrombin complex concentrate (PCC) and vitamin K. The aim of this observational cohort study was to evaluate the impact of guideline concordant administration of PCC and vitamin K on seven-day mortality.
methodsData from consecutive patients treated with PCC were prospectively collected in 44 emergency departments. Type of hemorrhage, coagulation parameters, type of treatment and seven-day mortality mortality were recorded. Guideline-concordant administration of PCC and vitamin K (GC-PCC-K) were defined by at least 20 IU/kg factor IX equivalent PCC and at least 5 mg of vitamin K performed within a predefined time frame of eight hours after admission. Multivariate analysis was used to assess the effect of appropriate reversal on seven-day mortality in all patients and in those with intracranial hemorrhage (ICH).
resultsData from 822 VKA-treated patients with severe hemorrhage were collected over 14 months. Bleeding was gastrointestinal (32%), intracranial (32%), muscular (13%), and "other" (23%). In the whole cohort, seven-day mortality was 13% and 33% in patients with ICH. GC-PCC-K was performed in 38% of all patients and 44% of ICH patients. Multivariate analysis showed a two-fold decrease in seven-day mortality in patients with GC-PCC-K (odds ratio (OR) = 2.15 (1.20 to 3.88); P = 0.011); this mortality reduction was also observed when only ICH was considered (OR = 3.23 (1.53 to 6.79); P = 0.002).
conclusionsGuideline-concordant VKA reversal with PCC and vitamin K within eight hours after admission was associated with a significant decrease in seven-day mortality.
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