Abstract
An Institutional Survey of Warfarin Reversal in the Setting of Life-Threatening Bleeds
Blood, v 134(Supplement_1), 4981
13 Nov 2019
Abstract
Introduction: The bleeding risk of warfarin is well known. Therapeutic options for warfarin reversal in life-threatening bleeds include fresh frozen plasma (FFP), recombinant factor VIIa (rFVIIa), and prothrombin complex concentrate (PCC). Despite the theoretical advantage and clinical evidence supporting PCC, it is not widely used in the US. Methods: An online anonymous questionnaire was sent to all providers in the Tower Health System asking them about their practice, specialty, degree, years in practice, and basic questions regarding their comfort and frequency of prescribing anticoagulants. The questionnaire also asked the providers how they would manage ten various clinical scenarios related to anticoagulation management. One question specifically addressed the management of warfarin reversal in an 85-year-old presenting with hemorrhagic shock. Analysis of variance was used to compare the scoring means between groups while linear regression and Pearson's correlation coefficient measured the relationship between years of practice and test scores. Results: Out of 404 responders, 232 (57.4%) selected an incorrect answer and 212 (52.5%) incorrectly selected fresh frozen plasma as the answer to the question (see uploaded image) that addressed warfarin reversal in the setting of major bleeding. Those providers who answered this question correctly and those who answered it incorrectly had mean scores of 68.26% and 52.16% respectively on the overall survey (p value 0.000). Conclusion: As compared to FFP, the use of PCC for warfarin reversal is associated with a significant reduction in all-cause mortality. This project demonstrates a professional practice gap and serves to highlight an area in medicine where many providers are not practicing in accordance with evidence-based practice. Furthermore, this particular question from the survey discovered that providers who performed better on the survey were more likely to answer questions regarding anticoagulation reversal correctly. Figure
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Details
- Title
- An Institutional Survey of Warfarin Reversal in the Setting of Life-Threatening Bleeds
- Creators
- Ian Garrahy - Tower Health System, Wyomissing, PATushar Pawar - Reading HospitalAnthony Donato - Reading HospitalAmber Stevenson - Reading HospitalDaniel Forman - Reading Hospital
- Publication Details
- Blood, v 134(Supplement_1), 4981
- Publisher
- American Society of Hematology
- Number of pages
- 1
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Medicine (Graduate); General Internal Medicine
- Web of Science ID
- WOS:000577164605054
- Other Identifier
- 991022161841504721