SEARCHCOHORTcritical care, hematology

cohort·critical care, hematology, gastroenterology, emergency medicine, internal medicine·PMC10087488

Prothrombinex®‐ VF in chronic liver disease: Friend or foe?

Emergency Medicine Australasia · 5 authors, 8 centres

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FIDELITY 100%

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TL;DR

A significant proportion of patients with ACLF (53%) developed markers of DIC, including worsening hypofibrinogenemia (60%) and thrombocytopenia (60%).

Full summary

531 CHARS

A significant proportion of patients with ACLF (53%) developed markers of DIC, including worsening hypofibrinogenemia (60%) and thrombocytopenia (60%). The overall incidence of venous thromboembolism was 6%, and overall mortality was 43%, with mortality reaching 70% in the ACLF subgroup. Limitations include the retrospective design, small sample size, and potential for pre-existing undiagnosed DIC. The authors conclude Prothrombinex®-VF should be used with caution in CLD, especially in ACLF, and its efficacy remains unproven.

STUDY TYPE

cohort

SPECIALTY

critical care

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AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10087488

Prothrombinex®‐ VF in chronic liver disease: Friend or foe?

Emergency Medicine Australasia

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ABSTRACT

Abstract Objective Management of coagulopathy in chronic liver disease (CLD) poses a challenge for critical care physicians. Prothrombinex®‐VF is a low‐volume product with rapid onset of action. Evidence for its efficacy and safety in CLD is limited and cases of acute intravascular coagulation and fibrinolysis (AICF) and/or disseminated intravascular coagulation (DIC) have been reported. Our objective was to evaluate the role of Prothrombinex®‐VF in reversal of coagulopathy and the incidence AICF/DIC, thromboembolic events and mortality. Methods This was a retrospective, multi‐centre study of Prothrombinex®‐VF use in CLD across 11 hospitals over a 2‐year period, excluding those on therapeutic anticoagulation. Patients were subclassified into acute on chronic liver failure (ACLF), acute decompensation (ADC) and compensated cirrhosis. Reversal of coagulopathy was defined as international normalised ratio (INR) <1.5× upper limit normal (ULN), prothrombin time <1.5× ULN, activated partial thromboplastin time <1.5× ULN and fibrinogen >1 g/L. Markers of AICF/DIC were recorded. Results Thirty CLD patients were included, and the median model for end‐stage liver disease score was 23.5. Acute bleeding was the most common indication for Prothrombinex®‐VF (60%). All had baseline coagulopathy and the majority did not achieve reversal. Key indicators of AICF/DIC were mainly observed in those with ACLF; bleeding from mucosa or lines (53%), worsening hypofibrinogenaemia (60%), worsening thrombocytopaenia (60%). The ADC and compensated cirrhosis groups were relatively unaffected. Incidence of venous thromboembolism was 6%. Overall mortality was 43% and 70% in ACLF. Conclusion Prothrombinex®‐VF did not lead to meaningful reversal of coagulopathy and should be used with caution in CLD. Patients with ACLF were more likely to develop AICF/DIC following Prothrombinex®‐VF, although the association is uncertain. Further studies are needed to evaluate the safety and efficacy of Prothrombinex®‐VF use in CLD.

CITATION EXPORT

Akmez Latona, Kate Hill, Aurelia Connelly et al.. Prothrombinex®‐VF in chronic liver disease: Friend or foe?. Emergency Medicine Australasia. (2022). https://doi.org/10.1111/1742-6723.14058

AUTHORS

5 · 8 CENTRES

Akmez Latona, Kate Hill, Aurelia Connelly, Katherine Stuart, Peter Wood

1 Department of Emergency Medicine Ipswich Hospital Ipswich Queensland Australia
2 Department of Emergency Medicine Princess Alexandra Hospital Brisbane Queensland Australia
3 Department of Emergency Medicine St Vincent's Private Hospital Toowoomba Queensland Australia
4 The University of Queensland Brisbane Queensland Australia
5 Department of Haematology Princess Alexandra Hospital Brisbane Queensland Australia
6 Griffith University Brisbane Queensland Australia
7 Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia
8 Department of Haematology Calderdale and Huddersfield NHS Foundation Trust Huddersfield England