Our physicians are pressuring our Blood Bank to start stocking Factor X, Prothrombin Complex Concentrates, etc. for reversal of Apixaban, Xarelto, Pradaxa, etc as they are routinely prescribing these dregs to their patients. Our pharmacy does NOT want to stock factor concentrates. The problem is the expense, return policies, etc. We would like to know how other facilities are handling factor concentrates. Does your facility stock these factor concentrates? If so, in the Pharmacy or Blood Bank? Thank you!

Our pharmacy stocks FVIIa for this purpose. What we are running into is the cardiology guys want to give a dose then get a thrombin time prior to the 2nd dose in case they have successfully dealt with the patient. From what I understand, 2 doses of FVIIa are what is recommended . . . We do not do thrombin times (yet!). I also believe the FDA has instructed the manufacturers that they need to develop an antagonist to their products before any more will be released by the feds.

pharmacy is responsible.

Pharmacy. PCC & VIIa.

I argue that recombinant products are not blood products or blood components, they are drugs.

At our hospital, pharmacy is responsible.  And requests for new products must go through P&T committee.

We handle all factors through the Blood Bank.  Our Medical Director is consulted for proper dosing so he would like it to stay in Blood Bank.  Factors are very unpredictiable when it comes to budgeting.  We do get our products on consignment so we do not have to worry about the cost of outdating. 

Hi Bev,

 

I still have the factors in Blood Bank, although recently our Transfusion Committee chairmen, when achieving the goal of getting approval for bringing FEIBA in-house, has explicitly stipulated that he wants Pharmacy to handle it...... its an antidote not a blood product....etc.....and so the turf wars begin! (Our pharmacy prefers us to handle them).

 

At any rate, I have a consignment contract through a company called Bio- Care. I believe Tufts and Children's use it as well. I stock our most frequently requested products, Humate-p, advate, novoseven, to name a few, and I can add FEIBA if need be.

 

The Bio Care rep tracks use and inventory, and ships back close dated product herself to forward to a facility that can use it prior to expiration. Pricing is through our Premier contract, and I've never paid for anything a patient didn't use. I have had this contract since 2010, and am quite pleased with the speed to which I can get product when needed.

 

Hope this helps.

 

Linda

There has been a historical standing that BB handles all this. The only benefit is that we know what patients are getting if problems with XM (or any other aspect) arises. We have tried shifting to pharmacy, but the resistance is strong. Intend to putting before Transfusion Committee at next meeting - but still expect strong resistance.

Cheers

Eoin

Pharmacy has ours. The latest data I read is there is still NO reversal agent for Xarelto or Pradaxa. They still insist on giving FFP here, but we try very hard to talk them out of it...exposing them to risk with no clinical benefit. So I would hate to throw a really expensive clotting factor at them that won't work either.

Blood bank handles Factors at our facility. We also have a consignment agreement and therefore don't have to worry about outdating. We were requested to stock PCCs. We are using Factor IX (profilnine)

I guess it depends what is being used. Pradaxa (Dabigatran) for instance is a thrombin inhibitor and other inhibit different factors and yes for some of them there are no reversal agents. I have seen a number of articles on haemodynamic support of bleeding patients who are on these, but haven't seen any definitive one yet that has wide acceptance and support, but they do need support ( thankfully most have a short half-life).

Cheers

Eoin

Re: 1/2 life of Dabigitran is 14 hours. However, this drug is cleared by renal excretion. If creat clearance is impaired, the 1/2 life of Dabigitran can be much longer. I remember attending an AABB lecture on this where there were cases that took 4-5 days to return the Thrombin Time to normal values. Anecdotal studies at McMaster revealed some benefit to using FEIBA for large bleeds with patients on dabigitran. Therefore we will stock FEIBA for these instances.  I have seen studies showing the PCCs do nothing to coag results on patients taking dabigitran. However, PCCs do apparently correct Fac10 inhibitors (PCCs also rapidly correct warfarin). We in blood bank carry all these products since in Canada, the Canadian Blood Service supplies them all.

Edited May 7, 201312 yr by marvy1

What is FEIBA?

Factor VIII inhibitor bypass activity.