Majeed A, et al. – In this cohort study, the effectiveness of prothrombin complex concentrates (PCC) given for management of major bleeding events (MBE) on rivaroxaban or apixaban, was investigated. As per findings, the administration of PCC for management of MBE associated with rivaroxaban or apixaban was effective in most cases. PCC displayed an association with a low risk of thromboembolism.

• Patients treated with PCC for management of MBE on rivaroxaban or apixaban, were incorporated between 1/1/2014 and 1/10/2016.
• The clinicians evaluated the effectiveness of PCC by using the International Society of Thrombosis and Hemostasis' Scientific and Standardization Subcommittee criteria for the assessment of effectiveness of major bleeding management.
• Thromboembolic events and all-cause mortality within 30 days after treatment with PCC, were safety outcomes.
• PCC was given to 84 patients for the reversal of rivaroxaban or apixaban due to a MBE.
• These patients received PCC at a median (interquartile range) dose of 2000 IU (1500-2000).
• Followed by gastrointestinal bleeding in 13 (15.5%) patients, intracranial hemorrhage (ICH) was the commonest site of bleeding requiring reversal (n=59, 70.2%).
• Furthermore, management with PCC was assessed as effective in 58 (69.1%) patients, and ineffective in 26 (30.9%) patients.
• Data demonstrated ICH (n=16, 61.5%) in most patients with ineffective hemostasis with PCC.
• They revealed the development of ischemic stroke in two patients, occurring five and ten days after treatment with PCC.
• Within 30 days after MBE, twenty-seven (32%) patients died.