2025 Southeastern Residency Conference

Title: Assessment of the Implementation of a fixed dose PCC protocol

Authors: Loren Proctor, Patrick Blakenship, Kyle Allmond, Brad Crane, Madison Sullivan, and Joy Bussey

Background: In August 2023, Blount Memorial Hospital (BMH) undertook a significant change in its protocol for managing anticoagulation reversal by transitioning from a weight-based activated 4-factor prothrombin complex concentrate (FEIBA) to a fixed-dose inactivated 4-factor prothrombin complex concentrate (KCENTRA). For several years prior to this transition, FEIBA had been the preferred agent for reversing anticoagulation. Since its adoption in 2016, FEIBA had served as the cornerstone for managing patients in the Emergency Department (ED) who required urgent anticoagulation reversal due to its efficacy in counteracting the effects of anticoagulation. However, the decision was made to move to KCENTRA, a fixed-dose product known for its precision and reliability in critical interventions. Historically, BMH has seen a consistent need for 4-factor prothrombin complex concentrates, with approximately 2 to 3 patients in the ED each month requiring this type of intervention. The introduction of KCENTRA is expected to streamline the administration process and enhance the overall effectiveness of anticoagulation reversal, reflecting the hospital’s dedication to continuous improvement and patient safety in emergency care.

Methods: 
This is an IRB-approved, retrospective analysis study to evaluate the effects of the transition from weight-based activated 4-factor prothrombin complex concentrate (FEIBA) to a fixed-dose inactivated 4-factor prothrombin complex concentrate (KCENTRA) at BMH. A report will be generated for all patients who received 4-factor PCC for Xa inhibitor reversal in the ED. This includes documentation of the order submission to drug administration and the subsequent verification by the pharmacist. Additionally, there will be a collection and assessment of the financial aspects related to the administration of 4-factor PCC for Xa inhibitor reversal. 

The primary objective will compare the time from order submission to administration time between FEIBA and KCENTRA. As for the secondary objectives, evaluation of the duration from order submission to pharmacist verification, as well as the assessment of the financial impact of transitioning from a weight-based dosing regimen to a fixed dosing regimen will be analyzed.

Results: When comparing the time difference from order submission to administration time, it was found that weight-based dosing (FEIBA) was significantly faster than fixed-dose (KCENTRA) by 6 minutes. When comparing the time difference from order submission to pharmacist verification, it was found that weight-based dosing (FEIBA) was faster than fixed-dose (KCENTRA) by 1.3 minutes. However, when analyzing finances, it was found that fixed-dose (KCENTRA) surpassed weight-based dosing (FEIBA) due to its significant financial savings of $4,053 per patient. 

Conclusion: The data we collected in regard to order submission, administration time, and pharmacist verification all favored weight-based dosing (FEIBA). However, due to the significant financial savings with fixed-dose (KCENTRA), our institution continued with fixed-dose (KCENTRA) as the 4F-PCC of choice. 

Self-Assessment Question: True or False: When changing from FEIBA® to KCENTRA®, the financial impact was more beneficial.