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{
    "pk": 11623,
    "title": "Impact of a Pharmacist-Driven Prothrombin Complex Concentrate Protocol on Time to Administration in Patients with Warfarin-associated Intracranial Hemorrhage",
    "subtitle": null,
    "abstract": "Introduction: \nAdvancements in the treatment of warfarin-associated intracranial hemorrhage (ICH) include the use of four-factor prothrombin complex concentrate (4F-PCC), which has demonstrated more rapid reversal of the international normalized ratio (INR) when compared with fresh frozen plasma. A pharmacist-driven protocol for 4F-PCC was implemented within our institution, which allows for pharmacist approval of 4F-PCC in patients diagnosed with warfarin-associated ICH and an INR ≥2. The pharmacist is responsible for determining the appropriate dose of 4F-PCC, preparation, bedside delivery, and order entry into the electronic medical record. Prior to implementation of the new protocol, the blood bank was responsible for 4F-PCC approval, dosing, product preparation, and arranging delivery with emergency department (ED) staff. The purpose of this study was to evaluate the impact of a pharmacist-driven protocol on time to 4F-PCC administration in warfarin-associated ICH.\nMethods:\n We performed a retrospective review of consecutive patients who received 4F-PCC in a single ED from September 2015 through February 2017. Patients ≥18 years old were eligible for inclusion based on three criteria: confirmed diagnosis of ICH; confirmed warfarin use; and INR ≥2. Secondary outcomes included dose of 4F-PCC in concordance with INR and weight-based dosing recommendations and hospital protocol, as well as concomitant intravenous vitamin K administration. \nResults:\n A total of 48 patients met inclusion criteria for the study with 24 patients in each protocol group. The median time to administration of 4F-PCC in the pharmacist-driven protocol group was 35 minutes (interquartile range [IQR] [25-62]; range, 11-133) compared with 70 minutes (IQR [34-89]; range, 14-244) in the pre-protocol group (p=0.034). We saw no differences for appropriate 4F-PCC dosing based on INR and patient weight between the two groups. \nConclusion:\n Implementation of a pharmacist-driven protocol for 4F-PCC in the ED at our institution significantly reduced time to administration in patients presenting with warfarin-associated ICH.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "pharmacist-driven protocol, warfarin reversal, four-factor prothrombin complete concentrate"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/22m675wh",
    "frozenauthors": [
        {
            "first_name": "Jessica",
            "middle_name": "L.",
            "last_name": "Corio",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Jonathan",
            "middle_name": "H.",
            "last_name": "Sin",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Bryan",
            "middle_name": "D.",
            "last_name": "Hayes",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts\nHarvard Medical School, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Joshua",
            "middle_name": "N.",
            "last_name": "Goldstein",
            "name_suffix": "",
            "institution": "Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts\nMassachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Lanting",
            "middle_name": "",
            "last_name": "Fuh",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2018-02-14T02:06:05Z",
    "date_accepted": "2018-02-14T02:06:05Z",
    "date_published": "2018-08-13T17:05:46Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11623/galley/6257/download/"
        }
    ]
}