Detailed description of patients receiving prothrombin complex concentrate for treatment of rivaroxaban-related bleeding
| Gender; age . | Indication for and dosage of rivaroxaban . | Site of bleeding . | Time admission: PCC . | PCC dosage . | Coagulation state on admission . | Coagulation state after PCC . | Bleeding outcome assessment . | Outcome at day 90 . |
|---|---|---|---|---|---|---|---|---|
| M; 80 y | SPAF; 15 mg OD ASA 100 mg (CAD with CABG, 1997; PCI, 2012) | Traumatic subdural hematoma | 3.5 h | 2000 IU initially, followed by 3000 IU 2 h later (47 IU/kg total) | INR 2.69 PT ratio 29% aPTT 43 s | INR 2.42 PT ratio 32% After another 3000 IU PCC: INR 2.25 PT ratio 34% aPTT 42 s | Patient also received 2 U FFP (500 mL); emergency trepanation, after 24 h: stabilization of subdural hematoma in CT scan | Pneumonia and death from septic shock at day 16 |
| M; 82 y | SPAF with recent stroke; 20 mg OD (last intake 28 h before admission) | Intracerebral bleeding | 5.5 h (delayed, since last intake of rivaroxaban >24 h; PCC only given after bleeding progression in CT scan) | 2000 IU (18 IU/kg) | INR 1.33 PT ratio 63% aPTT 32.7 s | INR 1.13 PT ratio 81% aPTT 31 s | Initial progression (from 1 × 1 × 1 cm to 6 × 3 × 2 cm) of hematoma, application of PCC resulted in stabilization in follow-up CT scan, patient died of ICB | Death at day 7 |
| M; 64 y | SPAF; 20 mg OD | Upper GI bleeding and epistaxis following acute renal failure | 14 h (before GI endoscopy) | 2000 IU (21 IU/kg) | INR 2.7 PT ratio 26% aPTT 49 s | Not done | Stabilization after endoscopy, transfusion, dialysis (for acute renal failure), and interruption of rivaroxaban | Survived without sequelae |
| F; 82 y | SPAF; 20 mg OD | Spontaneous hematothorax | 1.0 h | 2000 IU (39 IU/kg) | INR 1.58 PT ratio 46% aPTT 36.1 s | Not done | Patient also received 1 U FFP (250 mL) and 2 U RBC | Survived without sequelae |
| M; 75 y | VTE; 20 mg OD | Intraoperative bleeding during emergency cholecystectomy | 22 h (delayed, since last intake of rivaroxaban >24 h; PCC only given after manifest intraoperative bleeding) | 2000 IU (41 IU/kg) | INR 1.6 PT ratio 50% aPTT 31 s | INR 1.3 PT ratio 65% aPTT 35 s | Patient also received 1 U platelets, 2 g fibrinogen, 4 U FFP (1000 mL), and 2 U RBC; no further complications during or after surgery; discharge after 11 d | Survived without sequelae |
| F; 77 y | VTE; 15 mg OD clopidogrel 75 mg (NSTEMI, 2009) | Upper GI bleeding | 1 h | 1200 IU (20 IU/kg) | INR 4.0 PT ratio 17% aPTT 65.8 s | INR 1.4 PT ratio 62.1% aPTT 37.8 s | Stabilization after endoscopy | Survived without sequelae |
| Gender; age . | Indication for and dosage of rivaroxaban . | Site of bleeding . | Time admission: PCC . | PCC dosage . | Coagulation state on admission . | Coagulation state after PCC . | Bleeding outcome assessment . | Outcome at day 90 . |
|---|---|---|---|---|---|---|---|---|
| M; 80 y | SPAF; 15 mg OD ASA 100 mg (CAD with CABG, 1997; PCI, 2012) | Traumatic subdural hematoma | 3.5 h | 2000 IU initially, followed by 3000 IU 2 h later (47 IU/kg total) | INR 2.69 PT ratio 29% aPTT 43 s | INR 2.42 PT ratio 32% After another 3000 IU PCC: INR 2.25 PT ratio 34% aPTT 42 s | Patient also received 2 U FFP (500 mL); emergency trepanation, after 24 h: stabilization of subdural hematoma in CT scan | Pneumonia and death from septic shock at day 16 |
| M; 82 y | SPAF with recent stroke; 20 mg OD (last intake 28 h before admission) | Intracerebral bleeding | 5.5 h (delayed, since last intake of rivaroxaban >24 h; PCC only given after bleeding progression in CT scan) | 2000 IU (18 IU/kg) | INR 1.33 PT ratio 63% aPTT 32.7 s | INR 1.13 PT ratio 81% aPTT 31 s | Initial progression (from 1 × 1 × 1 cm to 6 × 3 × 2 cm) of hematoma, application of PCC resulted in stabilization in follow-up CT scan, patient died of ICB | Death at day 7 |
| M; 64 y | SPAF; 20 mg OD | Upper GI bleeding and epistaxis following acute renal failure | 14 h (before GI endoscopy) | 2000 IU (21 IU/kg) | INR 2.7 PT ratio 26% aPTT 49 s | Not done | Stabilization after endoscopy, transfusion, dialysis (for acute renal failure), and interruption of rivaroxaban | Survived without sequelae |
| F; 82 y | SPAF; 20 mg OD | Spontaneous hematothorax | 1.0 h | 2000 IU (39 IU/kg) | INR 1.58 PT ratio 46% aPTT 36.1 s | Not done | Patient also received 1 U FFP (250 mL) and 2 U RBC | Survived without sequelae |
| M; 75 y | VTE; 20 mg OD | Intraoperative bleeding during emergency cholecystectomy | 22 h (delayed, since last intake of rivaroxaban >24 h; PCC only given after manifest intraoperative bleeding) | 2000 IU (41 IU/kg) | INR 1.6 PT ratio 50% aPTT 31 s | INR 1.3 PT ratio 65% aPTT 35 s | Patient also received 1 U platelets, 2 g fibrinogen, 4 U FFP (1000 mL), and 2 U RBC; no further complications during or after surgery; discharge after 11 d | Survived without sequelae |
| F; 77 y | VTE; 15 mg OD clopidogrel 75 mg (NSTEMI, 2009) | Upper GI bleeding | 1 h | 1200 IU (20 IU/kg) | INR 4.0 PT ratio 17% aPTT 65.8 s | INR 1.4 PT ratio 62.1% aPTT 37.8 s | Stabilization after endoscopy | Survived without sequelae |
aPTT, activated partial thromboplastin time; ASA, acetylsalicylic acid; CABG, coronary artery bypass graft; CAD, coronary artery disease; CT, computed tomography; GI, gastrointestinal; ICB, intracranial bleed; IU, international units; NSTMI, non-ST segment elevation myocardial infarction; OD, once daily; PCI, percutaneous coronary intervention; PT, prothrombin time.