(456) Cost Advantage of Fixed-Dose Four-Factor Prothrombin Complex Concentrate for Warfarin Reversal

Introduction: Four-factor prothrombin complex concentrate (4F-PCC) is indicated for anticoagulation reversal and restoration of hemostasis in patients with warfarin-associated hemorrhage. The package insert recommends 4F-PCC dosing based on patient’s weight and pre-treatment INR. However, an alternative to this recommendation has emerged to simplify dosing, reduce treatment delays, and potentially limit the risk of thromboembolism. Recent studies have shown that fixed dosing resulted in lower number of units given and was non-inferior to weight-based dosing. The goal of this study was to compare the amount of 4F-PCC used at UC San Diego Health for warfarin reversal with weight-based versus fixed dosing and determine potential cost savings.

Methods: A retrospective analysis of 4F-PCC use for emergent warfarin reversal between Jan 2021 to Dec 2021 was performed. The primary outcome was the cost difference of weight-based 4F-PCC dosing and fixed dose 4F-PCC. Other outcomes assessed were average units used based on each dosing modality, patient bleeding presentation, and time to administration.

Results: A total of 21 patients received 4F-PCC for emergent warfarin reversal in 2021. The average weight was 88.2 kg and all patients received concomitant vitamin K. Intracranial hemorrhage was the most common bleeding presentation accounting for 52.3% of patients. An average of 2488 units per dose was administered to patients using weight-based dosing. However, if the fixed dosing scheme was employed, an average of 1690 units would be used. Implementation of fixed dosing would result in a cumulative reduction of 16,756 units used per year compared to weight-based dosing (35,500 units vs 52,256 units) resulting in a potential savings of $59,986.48 using the average wholesale price of $3.58 per unit. The average time from order placement to the start of infusion was 40 min with order verification accounting for 8 min, product reconstitution and pharmacist check accounting for 15 min, and check to administration accounting for 17 min.

Conclusions: Previous literature established clinical non-inferiority of fixed dose 4F-PCC compared to traditional weight based 4F-PCC. Based on the results of this retrospective analysis, changing to fixed dose 4F-PCC can reduce medication waste and cost by reducing the units administered.