Impact of Pharmacist Preparation of Four-Factor Prothrombin Complex Concentrate at the Bedside in Patients with Life-Threatening Hemorrhage in the Emergency Department

Abstract

Purpose: One option recommended by expert guidelines for prompt reversal of anticoagulation-induced hemorrhage is four-factor prothrombin complex concentrate (4F-PCC). Pharmacist presence has been shown to reduce order entry to administration and door-to-needle (DTN) times. However, how pharmacist preparation of 4F-PCC at the bedside in the Emergency Department (ED) can affect times to administration has not been thoroughly studied. The purpose of this study was to assess if pharmacist presence along with preparation of 4F-PCC at the bedside could improve administration times. Methods: This retrospective cohort study included anticoagulated patients requiring emergent reversal with 4F-PCC in the ED from January 2019 to April 2020 (pre-group) to March 2022 to March 2023 (post-group). Patients in the post-intervention group who had 4F-PCC prepared at the bedside were compared to a historical group without bedside 4F-PCC preparation. The primary outcome was time from 4F-PCC order entry to administration. Results: Of 193 patients evaluated, 99 (51.3%) were included (N = 41 pre-group; N = 58 post-group). There was a significant 11 minute difference in median time from order entry to administration favoring the post-group (31 vs 20 minutes, P < .001). The subset of patients with intracranial hemorrhage (ICH) in the post-group also had a significantly shorter order to administration time of 14 minutes (31 vs 17 minutes, P < .001). There was no difference in overall DTN times, in-hospital mortality, or length of stay (LOS) between groups, including in the subset of patients with ICH. Conclusion: 4F-PCC preparation at the bedside by the ED pharmacist significantly reduced 4F-PCC order entry to administration time. However, this intervention did not reduce overall DTN times.