Network meta-analysis for comparing the safety and efficacy of warfarin reversal strategies including plasma and prothrombin complex concentrates (PCCs).
Seven studies including 594 subjects using reversal agents plasma, 3-factor-PCC (Uman Complex and Konyne), and 4-factor-PCC (Beriplex/KCentra, Octaplex, and Cofact) met inclusion criteria. Compared with plasma, patients receiving Cofact probably have a higher rate of international normalized ratio (INR) correction (risk difference [RD] 499 more per 1000 patients, 95% confidence interval [CI], 176-761, low certainty[LC]); higher reversal of bleeding (323 more per 1000 patients, 11-344 more, LC); and fewer transfusion requirements (0.96 fewer units, 1.65-0.27 fewer, LC). Patients receiving Beriplex/KCentra probably have a higher rate of INR correction (476 more per 1000 patients, 332-609 more, LC); higher reversal of bleeding (127 more per 1000 patients, 43 fewer to 236 more); and similar transfusion requirements (0.01 fewer units, 0.31 fewer to 0.28 more, high/moderate certainty). Patients receiving Octaplex probably have a higher rate of INR correction (RD 579 more per 1000 patients, 189-825 more, LC).
PCCs probably provide an advantage in INR reversal compared to plasma. There was no added risk of adverse events with PCCs.
网络荟萃分析,用于比较华法林逆转策略(包括血浆和凝血酶原复合物浓缩物(PCCs))的安全性和有效性。
七项研究,包括594名受试者使用逆转剂血浆,3因素PCC(UmanComplex和Konyne),和4因子-PCC(Beriplex/KCentra,Octaplex,和Cofact)符合纳入标准。与等离子体相比,接受Cofact的患者可能具有更高的国际标准化比率(INR)校正率(风险差异[RD]每1000名患者中增加499,95%置信区间[CI],176-761,低确定性[LC]);出血逆转率更高(每1000名患者中增加323名,11-344更多,LC);输血需求减少(减少0.96个单位,减少1.65-0.27,LC)。接受Beriplex/KCentra的患者可能有更高的INR校正率(每1000名患者中增加476名,332-609更多,LC);出血逆转率更高(每1000名患者中增加127名,少43到多236);以及类似的输血要求(少0.01个单位,0.31少到0.28多,高/中等确定性)。接受Octaplex的患者可能有更高的INR校正率(每1000名患者中RD为579,189-825更多,LC)。
与血浆相比,PCC可能在INR逆转方面具有优势。PCCs没有增加不良事件的风险。