Research on the effect of fresh frozen plasma and prothrombin complex concentrate on cost, mortality and morbidity in patients using warfarin

Object: Patients using warfarin often present to the emergency department with complaints of bleeding. Warfarin is used in many diseases treatment and prophylaxis. The therapeutic range of warfarin is followed by an INR (International Normalized Ratio) measurement. The risk of thrombosis at lower values and bleeding at high values increases. The aim of this study was to evaluate the cost, morbidity and mortality rates of fresh frozen plasma (FFP) or prothrombin complex concentrate (PCC) used in warfarin overdose cases. Methods: Our study was performed retrospectively with 309 patients with elevated International Normalized Ratio (INR), admitted to the emergency department of Bezmialem Vakif University between 01.01.2015 and 31.12.2017. FFP or PCC treatments applied to these patients were investigated in detail and the results, cost effectiveness, morbidity and mortality rates were compared. Results: The mean age of the patients admitted to the emergency department and met the study criteria was 68±14.48. 71,5% of the patients were discharged from the emergency service and 8,4% were admitted to the intensive care unit. In evaluating the duration of hospitalization, 20,4% of the patients received more than 3 days of inpatient treatment. Warfarin overdose patients observed in emergency service with bleeding rates of %38,5 and without bleeding rates of %33. In most patients with major hemorrhage(76,5%), the INR value was above the therapeutic value as expected, and in etiology the most common cause was upper gastrointestinal (GIS) bleeding (%61.34). In the study, 89,3% of all patients treated with FFP and 10,7% of all patients treated with PCC. The mean decrease in INR value in patients receiving PCC was 6,64±5,62, and 4,16±4,29 receiving FFP. The amount of FFP use was 736 in all patients and costs 55.936 TL. Total PCC usage is 82 units and costs 40.590 TL. Conclusion: Most warfarin overdose patients are discharged from the emergency department. There is usually gastrointestinal bleeding in the etiology of major bleedings. The decrease in the INR value is higher in PCC than in FFP users, so PCC efficiency is superior to FFP. In terms of cost, although the number of FFP users is approximately 9 times higher than those using PCC, the total amount of cost is less. Mortality rates were similar in both groups. KEY : Warfarin, INR, FFP, PCC