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In the April issue of Transfusion journal, Joseph et al reported their 1 ½ -year experience with the use of 4 Factor Prothrombin Complex Concentrate (4F-PCC) for urgent reversal of Vitamin K antagonists (Transfus 2016;l 56: 799-807).

As the authors mentioned, their “…study supports the safety of 4F-PCC for urgent vitamin K antagonist reversal even in unselected patients.”

I highlight this article for several reasons.  It is incumbent upon those of us in the clinical laboratory, and especially the Blood Bank/Transfusion Service, to be aware of these new pharmaceutical agents that help provide rapid reversal of anticoagulants and allow for the potential elimination of unnecessary transfusions.  I have often found our clinical colleagues are unfamiliar with these strategies and we must take the lead in helping to establish protocols for their appropriate use.  This article speaks, as well, to the need for ongoing evaluation of these drugs in, as they state in their title, the “real-world” of medical practice.  Knowing how specific drugs affect outcomes outside of select studies with exclusions of particular patient populations (in this case, those with risk of thromboembolism) is so valuable to our everyday work.

Another reason that this article is important is it underscores the importance of collaboration.  The authors are representatives of departments of Pathology, the School of Medicine and Pharmacy.  It is vital that we, as laboratorians, push to participate alongside our clinical colleagues in the assessment and implementation of new therapies and adjuvant treatments.

It is obvious from the Transfusion Medicine perspective, that our Pharmacy “friends” play a huge role in patient care, often spearheading and specializing in areas such as anticoagulant reversal strategies, release of factor concentrates, antifibrinolytics, IVIg and albumin.  All of these pharmaceuticals can ultimately affect our laboratory testing and our potential interventions.  Be certain you have a representative from Pharmacy as a member of your Transfusion Committee!

It always pleases me to see not only excellent literature, but also ongoing collaboration with laboratory professionals often at the helm!

Author: Carolyn Burns, MD

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