Mustafa Emin CANAKCI, Muhammed Evvah KARAKILIC, Engin OZAKIN, Filiz Baloglu KAYA, Gizem Coşkun YÜKSEL, Seyhmus KAYA

VARFARİN DOZ AŞIMI OLAN OLGULAR İÇİN ACİLSERVİSTE PROTROMBİN KOMPLEKS KONSANTRESİKULLANIMI: GERİYE DÖNÜK ÇALIŞMA

Amaç: Çalışmanın amacı varfarin tedavisi alırken acil serviste (AS) International Normalized Ratio (INR) yüksekliği tespit edilen ve tedavide Protrombin Kompleks Konsantresi (PCC) kullanılan olguları uygulama sonuçları ile birlikte değerlendirmektir.Materyal ve Metot: Çalışma 01.01.2013-31.07.2019 arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Hastanesi Acil Servis’inde geriye dönük olarak yapıldı. Varfarin tedavisi alırken AS’de INR yüksekliği saptanan, PCC uygulama endikasyonu olan 18 yaş ve üstü hastalar çalışmaya dahil edildi. Demografik veriler, INR değerleri ve bunların mortalite ile ilişkileri değerlendirildi. Hedef INR değeri 1,5 olarak belirlendi.Bulgular: Değerlendirmeye alınan 106 olgunun yaş ortalaması 71 (28-97 aralığında) ve 59’u (%55,70) kadındı. Varfarin kullanım nedeni 42 (%39,60) olgu ile en sık atriyal fibrilasyondu. En sık PCC kullanım nedeni ise 48 (%45,30) olgu ile intrakraniyal kanama idi. Başvuru INR ortanca değeri 8,96 (Q-Q3: 5,06-15) idi. Başvuru INR değerleri ile PCC kullanma nedenleri arasında istatistiksel anlamlı ilişki saptanmadı (p= 0,93). PCC uygulaması sonrası kontrol INR ortanca değeri 1,43 (Q1-Q3: 1,26-1,91) bulundu. Olguların 49’unda (%46,00) hedef INR’ye ulaşıldığı görüldü. Olguların INR azalma oranlarının ortanca değeri 81 (Q1-Q3: 67-89) olarak belirlendi. 24 saatlik mortalite %1,97 iken 30 günlük mortalite %20,7 olarak saptandı. Başvuru ve kontrol INR değerleri ile mortalite arasında istatistiksel ilişki saptanmadı (p değerleri sırasıyla; 0,06-0,09). Tromboembolik olaya rastlanmadı.Sonuç: Varfarin doz aşımına bağlı kanaması veya kanama riski olan hastalarda kanamanın ciddiyeti dikkate alınarak tedavi verilmelidir. Varfarin kullanımına bağlı hayatı tehdit eden kanamalarda ve acil girişimlerde PCC kullanımı INR azalmasında etkin rol oynamaktadır.

USE OF PROTHROMBIN COMPLEX CONCENTRATE IN THE EMERGENCY DEPARTMENT FOR CASES WITH WARFARIN OVERDOSE: A RETROSPECTIVE STUDY

Objectives: The aim of the study is to evaluate the cases with warfarin therapy in which elevated InternationalNormalized Ratio (INR) was detected and Prothrombin Complex Concentrate (PCC) was used for treatment atthe Emergency Department (ED), and their treatment outcomes. Materials and Methods: The study was conducted retrospectively at the ED of Eskisehir Osmangazi UniversityMedical School between 01.01.2013-31.07.2019. Patients 18 years and older having Warfarin therapy who hadelevated INR and PCC indication at the ED were included in the study. Demographics, INR levels, and theirrelationship with mortality were evaluated. The target INR was set as 1.5. Results: The average age in 106 evaluated cases was 71 (range, 28-97) and 59 (55.70%) were female. The mostcommon reason for warfarin use was atrial fibrillation (42 cases-39.60%). The most common reason for PCCuse was intracranial hemorrhage (48 cases-45.30%). The initial median INR was 8.96 (Q1-Q3: 5.06-15). Therewas no statistically significant relation between initial INR and the reasons for PCC use (p=0.93). The controlmedian INR was 1.43 (Q1-Q3: 1.26-1.91). Target INR was achieved in 49 cases (49.00%). The median droplevels in INR was 81(Q1-Q3: 67-89). 24-hour mortality was 1.97% and 30-day mortality was 20.7%. There wasno statistically significant relation between initial INR and mortality (p=0.06-0.09, respectively). Nothromboembolic incident was encountered. Conclusion: In patients, who have hemorrhage or hemorrhage risk due to warfarin overdose, treatment shouldbe implemented considering hemorrhage. In life-threatening hemorrhages and emergency interventionsrelated to warfarin, PCC has an efficient role in INR reduction.

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