SynthesisBlood advances2019
Management of direct factor Xa inhibitor-related major bleeding with prothrombin complex concentrate: a meta-analysis.
Synthesis in Blood advances, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 3 of them syntheses 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
45 citing papers in PubMed, 3 syntheses or guidelines pooled it, 120 citations in OpenAlex.
- Prothrombin complex concentrate in major bleeding associated with DOACs; an updated systematic review and meta-analysis.Journal of thrombosis and thrombolysis · 2021Pooled it
- Guideline
- Guideline
- Cost comparison of andexanet versus prothrombin complex concentrates for direct factor Xa inhibitor reversal after hemorrhage.Journal of thrombosis and thrombolysis · 2020Trial
- Effect of PCC on thrombin generation in patients on FXaI with bleeding or needing urgent surgery (GAUGE).Blood advances · 2026Observational
- Emergency reversal of Rivaroxaban with Andexanet alfa in a child with hemorrhagic brain metastasis from Wilms tumor.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- Andexanet alfa for the reversal of anticoagulation: Dutch practice data.Research and practice in thrombosis and haemostasis · 2026Observational
- Direct Oral Anticoagulant Inhibitors: Mode of Action, Clinical Aspects.Handbook of experimental pharmacology · 2026Review
- Fixed-Dose Four-Factor Prothrombin Complex Concentrate for Reversal of Anticoagulation: Evaluation of Efficacy, Safety, and Cost Savings.Journal of hematology · 2025Article
- Position statement of the Polish Society of Gastroenterology on the use of andexanet alfa in patients with gastrointestinal bleeding taking factor Xa inhibitors.Przeglad gastroenterologiczny · 2025Article
- Co-administration of Four-Factor Prothrombin Complex Concentrate With Andexanet alfa for Reversal of Nontraumatic Intracranial Hemorrhage.Hospital pharmacy · 2024Article
- Management of DOAC-related bleeding in cancer patients: a single center-case series.Journal of thrombosis and thrombolysis · 2024Article
- Modelling the effects of 4-factor prothrombin complex concentrate for the management of factor Xa-associated bleeding.PloS one · 2024Article
- Clinical Care Pathway and Management of Major Bleeding Associated with Nonvitamin K Antagonist Oral Anticoagulants: A Modified Delphi Consensus from Saudi Arabia and UAE.Mediterranean journal of hematology and infectious diseases · 2024Review
- Real-world clinical outcomes among US Veterans with oral factor xa inhibitor-related major bleeding treated with andexanet alfa or 4-factor prothrombin complex concentrate.Journal of thrombosis and thrombolysis · 2023Article
- Aneurysmal Subarachnoid Hemorrhage in Hospitalized Patients on Anticoagulants-A Two Center Matched Case-Control Study.Journal of clinical medicine · 2023Article
- Four-factor prothrombin complex concentrate for the treatment of oral factor Xa inhibitor-associated bleeding: a meta-analysis of fixed versus variable dosing.Research and practice in thrombosis and haemostasis · 2023Article
- Impact of a pharmacist driven anticoagulation reversal program at a large academic medical center.Journal of thrombosis and thrombolysis · 2022Article
- Review
- [Management of bleeding in patients on antithrombotic therapy].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2021Review
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A targeted antidote for reversal of direct factor Xa (FXa) inhibitors is now available for clinical use in the United States, but it is costly and has limited availability. In a systematic review, we evaluated the safety and effectiveness of 4-factor prothrombin complex concentrate (4F-PCC) as an alternative for managing direct FXa inhibitor-related major bleeding. A systematic literature search was conducted using Medline, Embase, and the Cochrane Register of Controlled Trials up to September 2018. No comparative studies were found. Ten case series with 340 patients who received PCC for direct FXa inhibitor-related major bleeding were included. The pooled proportion of patients with effective management of major bleeding was 0.69 (95% confidence interval [CI], 0.61-0.76) in 2 studies using the International Society on Thrombosis and Haemostasis (ISTH) criteria and 0.77 (95% CI, 0.63-0.92) in 8 studies that did not use the ISTH criteria; all-cause mortality was 0.16 (95% CI, 0.07-0.26), and thromboembolism rate was 0.04 (95% CI, 0.01-0.08). On the basis of evidence with very low certainty from single-arm case series, it is difficult to determine whether 4F-PCC in addition to cessation of direct oral FXa inhibitor is more effective than cessation of direct oral FXa inhibitor alone in patients with direct FXa inhibitor-related major bleeding.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.