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cost benefit of plasma vs 4 factor PCC


Mabel Adams
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Our pharmacy and therapeutics committee is reviewing their guidelines for use of 4 factor PCC.  They would like me to provide cost and risks of plasma transfusion.  Does anyone have data on the costs of transfusion besides the product itself?  Most of my data on transfusion risks is not specific to plasma. Better yet, maybe you have done this whole project and would like to share what you found?  Or please direct me to a good, recent article on the topic.

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you usually don't have to worry about causing a thromboembolic event with plasma.  I am not conversant with 4 factor PCC - is it akin to Kcentra?  My P&T committee just approved Kcentra 'cuz one of the surgeons thinks it takes too long to get plasma thawed ( <0.5hr here, usually about 20 min).  I know my Med Director is concerned because no one here really knows how to use it. I am concerned too.  I think they are going to store one dose in pharmacy.

 

I just looked it up - it is Kcentra.  Scary Mabel.  you can look on the kcentra website for info.

Edited by David Saikin
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We already stock it for life-threatening hemorrhages needing warfarin reversal (the original FDA approved indication).  It is also in our list of things to try to reverse the new oral anticoagulants when the patient is bleeding out.  I would like them to add it to the list of options for patients needing warfarin reversal for an urgent procedure who are at significant risk of circulatory overload.  I thought the old 3 factor PCC (not Kcentra) was more prone to the thromboembolism risk than the new four factor PCC, but I am no expert.  I think they use it a lot in Europe for reversing warfarin when vitamin K isn't fast enough.

 

Having recently seen a fatal TRALI case, I have a healthy respect for plasma transfusion risks.

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We stock the 4-factor PCC (KCentra). Stops a brain hemorrhage much faster and with much less volume than multiple units of FFP.  It may cost a bit more, but if it saves a brain...

 

See attached for a journal article about it, and our Epic tip sheet that has indications, dosing, etc.

CHEST journal article about use of Kcentra.pdf

Kcentra Epic tip sheet.pdf

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I agree with Terri - the pharmacy at our hospital is going to stock PCC once the policy for indications is written. We had a patient last Thursday that was the perfect candidate, could have taken him to surgery one to two hours earlier if we had the PCC instead of using FFP. The cost is a lot, but the chief of surgery wants to stock for when he feels it is necessary. Fortunately for us, it will be distributed by the pharmacy.

Liz

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  • 1 month later...

We stock it for warfaring reversal and some surgeons will request it as a last ditch effort to save the patient - they understand it is only given when all other avenues have been exhausted and not as a first line.

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