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Paper Chase 1: PCC vs. FFP

Mel Herbert, MD MBBS FAAEM, Sanjay Arora, MD, and Mike Menchine, MD
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EM:RAP 2013 December - Summary 1 MB - PDF

Sanjay and Mike discuss PCC vs. FFP...if you want a little to go a long way fast, it's lookin' like PCC is the choice of champions.

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David P. -

Love the new style! As an intern, these segments are gold. The more, the better. Thanks guys!

Thomas D. -

What about pretreatment with pcc for invasive procedure in patient with elevated INR?

Joseph C. M., M.D. -

It would appear from the small study and abstract you mentioned that 4-Factor PCC is likely better than FFP alone.

However, recommendations for Coumadin reversal prior to Kcentra release are for 3-Factor PCC + 2-4 units of FFP. Are you aware of any head-to-head studies comparing outcomes of 3-Factor PCC + 2-4 units of FFP vs. 4-Factor PCC?

Our hospital is debating whether evidence supports increased cost of 4-Factor PCC compared to 3-Factor PCC + FFP.

Nilesh P., D.O. -

Question and comment...
Question: What is the recommendation for reversal for an elevated INR with minor bleeding, such as epistaxis or hematuria. I believe the CHEST guidelines do a nice job of outlining reversal recommendations for elevated INR and no bleeding or elevated INR and major bleeding. But what about minor bleeding--to me, this is the dilemma.

Comment: In regards to the previous comment, to my knowledge, there are no head to head trials of 3 factor vs 4 factor PCC.
However, I don't believe the cost difference to be that significant. It varies institution to institution, however, the approximate cost of 3 factor PCC/unit
(I won't mention specific product) is 97 cents. The approximate cost for Kcentra/unit is $1.27. But then you must weigh in the cost of giving FFP with the 3 factor PCC. Also with 3 factor, there is data showing incomplete reversal and when this happens, you would re-dose the 3 factor and the cost will then exceed 4 factor.
Also the podcast stated the cost of a 4 factor dose is $4,500. I'm not sure where that comes from.

Nilesh

Robb R. -

Question for you experts:
I practice in a rural area - nearest surgeon 120 miles away. We have only 6 units of o Neg blood. I would like to beef up our resources but I'm not sure what to add with our limited resources. FFP vs PCC vs TXA. What would be the best bang for the buck for our trauma patients/ warfarin head bleeds etc.?
Any comments would be appreciated

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Episode 147 Full episode audio for MD edition 275:31 min - 130 MB - M4AResumen del EM:RAP Diciembre 2013 Español 83:52 min - 115 MB - MP3EM:RAP 2013 December Bonus MP3 47 MB - ZIPEM:RAP 2013 December MP3 272 MB - ZIPEM:RAP 2013 December - Summary 1 MB - PDFEM:RAP December 2013 Board Review Questions 594 KB - PDFEM:RAP December 2013 Board Review Answers 456 KB - PDF

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