Thrombosis and survival after prothrombin complex concentrate use to treat oral anticoagulant associated haemorrhage

Recent trials for treatments of direct oral anticoagulant <br/>(DOAC) related acute haemorrhage have highlighted <br/>incidences of post treatment thrombosis. Prothrombin <br/>complex concentrate (PCC) is widely used for reversal of <br/>anticoagulant associated bleeding, yet thrombotic risks <br/>following PCC administration, particularly for DOACs, <br/>remain incompletely characterised in real-world settings.<br/>Methods<br/>This retrospective observational study analysed thrombotic <br/>and survival outcomes in 682 patients that received PCC <br/>for OAC associated haemorrhage in the Belfast Health <br/>and Social Care Trust between 2015-2021. Patients were <br/>categorised by OAC type (warfarin, rivaroxaban, apixaban <br/>and edoxaban). Primary outcome was thrombotic event rate <br/>at 30 days, while secondary outcomes included 30- and 90<br/>day mortality and anticoagulation resumption rates.<br/>Results <br/>The cohort comprised 393 warfarin patients, 55 rivaroxaban, <br/>221 apixaban and 13 edoxaban patients. Intracranial <br/>haemorrhage predominated (47-69% across DOAC <br/>groups vs. 49% warfarin). Thrombotic event rates were <br/>significantly higher in DOAC patients (rivaroxaban 13%, <br/>apixaban 8%, overall DOAC 8.7%) compared to warfarin <br/>(5%). Thirty-day mortality rates ranged from 13-23% across <br/>oral anticoagulant groups. Anticoagulation was resumed in <br/>only 29-47% of patients.<br/>Conclusions<br/>The findings suggest that PCC may be as effective as specific <br/>antidotes for DOAC reversal. In the absence of universal <br/>access to specific reversal agents, PCC continues to serve <br/>an important role in managing life threatening anticoagulant <br/>associated haemorrhage. Systematic pathways for post <br/>reversal anticoagulation resumption should be implemented <br/>to optimise patient outcomes