Findings from a study involving obese patients administered 4-factor prothrombin complex concentrate (4F-PCC) for reversal of warfarin-associated emergent bleeding suggest that dosing in these patients should be based on actual body weight with a 100kg dose cap as per the labeling recommendations.

To investigate an appropriate dosing strategy for 4F-PCC (Kcentra; CSL Behring) in obese patients, the authors conducted a retrospective analysis comparing the reversal of warfarin using adjusted (N=28) vs actual body weight (N=50). Patients included in the analysis had similar baseline INR and BMI; the majority had intracranial hemorrhage. “The primary outcome was the percent of patients achieving coagulopathy reversal, defined as a post-treatment INR <1.4 for neurologic indications and <1.5 for all others,” the authors explained.

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Results showed that compared with the actual body weight group, goal INR attainment was significantly lower in the adjusted body weight arm (35.7% vs. 68%; P= .006); the median dose of 4F-PCC in the adjusted body weight group was 2120 units vs 2500 units in the actual body weight arm. In the post-hoc analysis, no differences in INR goal achievement were noted in either group when stratified by weight (<100kg vs ≥100kg).

Based on their findings, the authors suggest that clinicians dose 4F-PCC according to the prescribing information and use actual body weight in obese patients (100kg dose cap). They added that, “Given the lack of data on the safety and efficacy of administering 4F-PCC in obese patients, further research is warranted to understand the impact obesity may have on clinical outcomes.”

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