ArticleNeurocritical care2017
Fixed Versus Variable Dosing of Prothrombin Complex Concentrate in Vitamin K Antagonist-Related Intracranial Hemorrhage: A Retrospective Analysis.
Article in Neurocritical care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
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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.
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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.
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Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Emerging trends in anticoagulation therapy: a bibliometric analysis of DOACs and endogenous coagulation pathway inhibitors.Naunyn-Schmiedeberg's archives of pharmacology · 2025Pooled it
- Comparison of 4-factor fixed-dose versus 4-factor weight-based-dose prothrombin complex concentrate for emergent warfarin reversal: a systematic review and meta-analysis.Clinical and experimental emergency medicine · 2025Pooled it
- Safety and efficacy of fixed versus variable-dose prothrombin complex concentrate for emergent reversal of vitamin K antagonists: A systematic review and meta-analysis.The American journal of emergency medicine · 2024Pooled it
- Trial
- A Novel Fixed-Dose Activated Prothrombin Complex Concentrate Regimen for Warfarin-Associated Hemorrhages: A Retrospective Cohort Comparison of Two Regimens.Pharmacy (Basel, Switzerland) · 2026Article
- A retrospective comparison of the emergent use of fixed-dose four-factor prothrombin complex versus weight-based dosing for intracranial hemorrhage assessing medication delivery time and cost.International journal of physiology, pathophysiology and pharmacology · 2023Article
- Fixed-Dose Factor Eight Inhibitor Bypassing Activity (FEIBA) in the Management of Warfarin-Associated Coagulopathies.Pharmacy (Basel, Switzerland) · 2022Article
- Fixed- versus variable-dose prothrombin complex concentrate protocol for vitamin K antagonist reversal.International journal of hematology · 2021Article
- Initiation of a fixed-dose four-factor prothrombin complex concentrate protocol.Journal of thrombosis and thrombolysis · 2020Article
- Collaborative Management Strategies for Drug Shortages in Neurocritical Care.Neurocritical care · 2020Review
- High-Dose 4-Factor Prothrombin Complex Concentrate for Warfarin-Induced Intracranial Hemorrhage.The Neurohospitalist · 2020Article
- Low-dose compared to manufacturer-recommended dose four-factor prothrombin complex concentrate for acute warfarin reversal.Journal of thrombosis and thrombolysis · 2019Observational
- Fixed-dose 4-factor prothrombin complex concentrate: we don't know where we're going if we don't know how to get there.Journal of thrombosis and thrombolysis · 2018Review
- Fixed dose 4-factor prothrombin complex concentrate for the emergent reversal of warfarin: a retrospective analysis.Journal of thrombosis and thrombolysis · 2018Article
- Low-dose Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Hemorrhage with INR Less Than 2.0.Neurocritical care · 2017Article
- Reversal of Oral Anticoagulants: A Survey of Contemporary Practice Trends (ReACT).Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMillions of patients receive vitamin K antagonist (VKA) therapy worldwide. Annually 0.2-1 % of all VKA users develops an intracranial hemorrhage (ICH). Prothrombin complex concentrate (PCC) is administered to restore the INR ≤ 1.5 in an attempt to limit hematoma growth. In order to facilitate PCC dosing, our hospital recently changed from a variable dose based on bodyweight, baseline- and target-INR, to a fixed 1000 IU fIX PCC dosing protocol for ICH.
methodsIn a before and after design, we compared successful achievement of an INR ≤ 1.5 with a fixed dosing strategy versus the variable dosing strategy of PCC in patients presenting with intracranial bleeding complications of VKA. Data of the two cohorts of patients were retrospectively collected from medical records.
resultsA median dosage of 1750 IU was given per patient in the variable dose group (n = 25) versus 1000 IU in the fixed dose group (n = 28). In the intention-to-treat analysis, 96 % achieved an INR ≤ 1.5 after an initial dose in the variable dose cohort compared to 68 % in the fixed dose cohort (p = 0.01). An additional dose was given in 2 (8 %) versus 9 (32 %) patients, respectively (p = 0.04). The median door-to-PCC-order time was 42 versus 32 min (p = 0.37) and the door-to-needle time was 81, respectively 60 min (p = 0.42).
conclusionThe fixed dose protocol necessitates additional PCC infusions more frequently to achieve a target INR ≤ 1.5. Door-to-order and door-to-needle time were shorter but, in this small cohort, not significantly so. The effect on clinical outcome remains unknown.
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