Purpose: To evaluate appropriate usage of 4-factor PCC based on indication and dosage in patients requiring urgent anticoagulation reversal experiencing a life-threatening bleed, or preparing for an invasive procedure/surgery at WellStar North Fulton Hospital.

Methods: The electronic health record system will identify patients who have received at least one dose of 4-factor PCC. Patient name and medical record number will be de-identified and excluded from data collection. The following data will be collected: patient age, gender, indication, specific agent being reversed (if available), dosage, total number of doses given, location of bleed, 30 minute INR differential, other factors or blood products utilized, concurrent administration of vitamin K and surgical or procedural interventions required.

Results: 4-factor PCC was appropriately indicated in 100% of the cases between March 1, 2018 and August 31, 2018. 4-factor PCC was correctly dosed in 54% of patients included in the review. 4-factor PCC was used most commonly for the reversal of non-warfarin agents such as direct oral anticoagulants (DOACs), with the exception of dabigitran.

Conclusion: Overall, we see the need for developing a protocol for non-warfarin reversal at our institution to facilitate choosing the correct dosages in life-threatening bleeds. We also recommend adding reversal agents for individual DOACs as they become available.