#4F_PCC - Twitter Hashtag

over 2 years ago

23a) So let’s discuss #4F_PCC - NOT FDA approved. Considered OFF Label for #FXai reversal - Std dosing not been clearly defined (hence "usual care arms" are hard to interpret) - Similar to warfarin reversal, we see Weight Based & Fixed Dosing - Create a protocol & stick to it

cardiomet_CE's tweet photo. 23a) So let’s discuss #4F_PCC
- NOT FDA approved. Considered OFF Label for #FXai reversal
- Std dosing not been clearly defined (hence "usual care arms" are hard to interpret)
- Similar to warfarin reversal, we see Weight Based & Fixed Dosing
- Create a protocol & stick to it https://t.co/qIryFv3x1o

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@cardiomet_CE

almost 3 years ago

27) We have a sense that the overall results favor #andexanet, as the trial was stopped early by the #DSMB. https://t.co/1KoINuGCIx But inquiring minds want to know--what proportion of the "usual care" patients received #4F_PCC??

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@cardiomet_CE

about 3 years ago

20) What impacted in-hospital mortality in pts with #GIB? 1⃣ Use of #andexanet_alfa vs. #4F_PCC ➡️⬇️☠️. 2⃣ Pts w/⬆️age, 3⃣impaired mental status, & 4⃣ DNR orders had higher mortality. So did pts w/ 5⃣ #liver disease, #CKD, and #HF. Some the same as #ICH, some different.

cardiomet_CE's tweet photo. 20) What impacted in-hospital mortality in pts with #GIB? 1⃣ Use of #andexanet_alfa vs. #4F_PCC ➡️⬇️☠️. 2⃣ Pts w/⬆️age, 3⃣impaired mental status, & 4⃣ DNR orders had higher mortality. So did pts w/ 5⃣ #liver disease, #CKD, and #HF. Some the same as #ICH, some different. https://t.co/QSCoWKrlrT

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@cardiomet_CE

about 3 years ago

12) In-hospital mortality across ALL bleed types was 50% lower for patients treated with #andexanet alfa vs #4F_PCC

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@cardiomet_CE

about 3 years ago

11) ALERT---💰💰 SLIDE! Surprising to no one, factors assoc'd w/ HIGHER ODDS of ☠️were #ICH, ⬆️age, impaired mental status, presence of #DNR order, liver disease, #CKD, & #HF. The only factor associated with LOWER ODDS of in-hospital ☠️ was the use of #andexanet_alfa vs #4F_PCC.

cardiomet_CE's tweet photo. 11) ALERT---💰💰 SLIDE!
Surprising to no one, factors assoc'd w/ HIGHER ODDS of ☠️were #ICH, ⬆️age, impaired mental status, presence of #DNR order, liver disease, #CKD, & #HF.
The only factor associated with LOWER ODDS of in-hospital ☠️ was the use of #andexanet_alfa vs #4F_PCC. https://t.co/BOu4oL6yiv

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@cardiomet_CE

about 3 years ago

6) While #andexanet alfa is approved for use by @US_FDA, uptake into practice has been slow, & some clinicians use #4F_PCC off-label. There is little evidence comparing these 2. In our recent work we sought to address this, using in-hospital #mortality as our primary endpoint.

cardiomet_CE's tweet photo. 6) While #andexanet alfa is approved for use by @US_FDA, uptake into practice has been slow, & some clinicians use #4F_PCC off-label. There is little evidence comparing these 2. In our recent work we sought to address this, using in-hospital #mortality as our primary endpoint. https://t.co/7aUJzowe0t

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@cardiomet_CE

about 3 years ago

5) An important ❓is how to reverse the effects of #DOACs (including the commonly used anti Xa DOACs such as #rivaroxaban & #apixaban) in an #ICH and #GIB in the #emergencydepartment #ED. The main options are #Andexanet_alfa & 4-factor prothrombin complex concentrate (#4F_PCC).

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@cardiomet_CE

over 3 years ago

12) If reversal IS indicated, then one must choose between specific #reversal or nonspecific factor #repletion. With anti-FXa DOACs, that's a choice between, respectively, #andexanet_alfa and a prothrombin complex concentrate, typically #4F_PCC.

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@cardiomet_CE

over 3 years ago

27a) Now let’s review the 🔑🥡🏡messages! 👉Reversal of FXa inhibition must be done ASAP in #ICH + (only) in life-threatening GI 🩸! 👉Until a 🗣️to 🗣️ RCT, guidelines & other guidance documents recommend #Andexanet over #4F_PCC.

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@cardiomet_CE

over 3 years ago

5) An important ❓is how to reverse the effects of DOACs (including the commonly used anti Xa DOACs such as rivaroxaban & apixaban) in an #ICH at the ED. The main options are #Andexanet_alfa & 4-factor prothrombin complex concentrate (#4F_PCC).

cardiomet_CE's tweet photo. 5) An important ❓is how to reverse the effects of DOACs (including the commonly used anti Xa DOACs such as rivaroxaban & apixaban) in an #ICH at the ED. The main options are #Andexanet_alfa & 4-factor prothrombin complex concentrate (#4F_PCC). https://t.co/DXbjbNjd1j

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@cardiomet_CE

almost 4 years ago

23) 4-factor prothrombin complex concentrate #4F_PCC is a human plasma-derived concentrate of vitamin K-dependent factors II, VII, IX and X approved for #warfarin reversal. In the setting of DOAC-related bleeds, 4F-PCC may enhance hemostasis by overcoming anticoagulant effect.

cardiomet_CE's tweet photo. 23) 4-factor prothrombin complex concentrate #4F_PCC is a human plasma-derived concentrate of vitamin K-dependent factors II, VII, IX and X approved for #warfarin reversal. In the setting of DOAC-related bleeds, 4F-PCC may enhance hemostasis by overcoming anticoagulant effect. https://t.co/5FFdiA2Elk

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@cardiomet_CE

almost 4 years ago

21) It's c. #Andexanet_alfa is an altered, biologically inactive #FXa decoy that reversibly binds #aFXa #anticoagulants. #4F_PCC is a repletion approach that includes all of the vitamin K-dependent coag factors (II, VII, IX, X).

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@cardiomet_CE

almost 4 years ago

20) Which of the following is a correct description of these options: a. #andexanet = #FAb fragment antibody b. #4F_PCC = specific reversal agent c. #andexanet = specific reversal agent d. #4F_PCC = #FAb fragment antibodies

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@cardiomet_CE

almost 4 years ago

10a) The faculty responded: There is no "gold standard" for #reversal of #anticoagulation in such cases. While other approaches such as #4F_PCC, #rFVIIa, and even #cryopreciptate have been reported and discussed, none has been approved for reversal of #apixaban or #rivaroxaban.

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