The Occurrence of Re-elevated INR During Hospitalization Following Reversal of Phenprocoumon with Prothrombin Complex Concentrate (PCC) and/or Phytomenadione: A Retrospective Study

Abstract

Background: The long half-life of the oral vitamin K antagonist (VKA) phenprocoumon (72-720 h) presents challenges in managing anticoagulation, particularly during reversal with prothrombin complex concentrate (PCC) and/or phytomenadione. This study investigates the incidence of International Normalized Ratio (INR) re-elevation 48 hours post-reversal and identifies factors influencing this outcome. Methods: We conducted a retrospective observational study on hospitalized patients receiving phenprocoumon, reversed with PCC and/or phytomenadione at the Dutch hospital Spaarne Gasthuis. Cox proportional hazards models were used to assess differences between patients with an INR ≥ 6 and < 6 at admission, as well as between patients in surgical versus non-surgical departments. A multivariate logistic regression analysis was performed to evaluate the contributions of various factors to the risk of re-elevated INR. Results: Of the 2972 admissions, 498 were included in the final analysis. Re-elevated INR was observed in 86/498 (17.3%) of the study population. Re-elevated INR was particularly noted in patients with an INR at admission ≥ 6 (37.5% vs. 10.8%, p < 0.01), and those in non-surgical departments (11.2% vs. 6.0%, p < 0.01). Conclusion: Our present study emphasizes that patients with an INR ≥ 6 upon admission or those treated in non-surgical departments face a higher risk of INR re-elevation 48 hours after reversal. Timely administration of additional doses of PCC or phytomenadione is essential to prevent this INR re-elevation and minimize the risk of potential (re)bleeding.