{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:57:42Z","timestamp":1787500662768,"version":"build-2736575974"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Octapharma","award":["2025-0985"],"award-info":[{"award-number":["2025-0985"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Anti-Xa assays are seldom rapidly available, prompting clinicians to frequently administer four-factor-prothrombin complex concentrate (4F-PCC) empirically.<\/jats:p>\n                  <jats:p>Determine if the thrombotic risk increases when preoperative factor Xa inhibitor (XaI) levels are low or unmeasured.<\/jats:p>\n                  <jats:p>We analyzed retrospectively all patients who received 4F-PCC between September 2018 and July 2024 at five hospitals in the Hamilton region and screened for those with emergency surgery\/invasive procedure as the main indication. The primary outcomes were symptomatic or asymptomatic, objectively verified arterial or venous thromboembolism within 7 days of 4F-PCC infusion. The secondary outcome was the same between postoperative days 8 and 30. XaI levels were determined with an anti-Xa assay, calibrated with the respective oral anticoagulant used by the patient.<\/jats:p>\n                  <jats:p>Four-F-PCC at a median dose of 2,000 units (interquartile range, 2,000\u20132,000) was administered to 227 patients on apixaban (143; 63%), rivaroxaban (72; 32%), or edoxaban (12;5%). The mean age was 76 years, and 42% were female. Prophylaxis against venous thromboembolism was started promptly in 214 patients (94%) after a median of 1 day (interquartile range, 1\u20132). Thromboembolism within 7 days occurred in 1 of 38 patients (3%) with high XaI level, 0 of 24 with low level, and 9 of 165 (5%) with no level.<\/jats:p>\n                  <jats:p>The risk of thromboembolism after 4F-PCC in patients on XaI and emergency surgery\/invasive procedures appears to be similar among patients with preoperative XaI levels that are high, low, or not measured. This information might be helpful in settings where rapid anti-Xa testing is unavailable.<\/jats:p>","DOI":"10.1055\/a-2834-0030","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:08:22Z","timestamp":1773792502000},"source":"Crossref","is-referenced-by-count":1,"title":["Safety of Prothrombin Complex Concentrate for Emergency Surgery According to the Oral Factor Xa Inhibitor Level"],"prefix":"10.1055","author":[{"given":"Ali","family":"Eshaghpour","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menaka","family":"Pai","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"},{"name":"Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Ibragimov","sequence":"additional","affiliation":[{"name":"Faculty of Science, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Schulman","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Obstetrics and Gynecology and Perinatal Medicine, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s11239-022-02671-z","article-title":"Four-factor prothrombin complex concentrate use for on-label versus off-label indications: a retrospective cohort study","volume":"55","author":"B D Adkins","year":"2023","journal-title":"J Thromb Thrombolysis"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1055\/s-0044-1788305","article-title":"Long-term safety of a four-factor prothrombin complex concentrate (Kcentra\/Beriplex P\/N): an updated pharmacovigilance review","volume":"125","author":"T J Milling","year":"2025","journal-title":"Thromb Haemost"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"2761","DOI":"10.1016\/j.jtha.2024.07.002","article-title":"Prothrombin complex concentrate for emergency surgery in patients on oral Xa-inhibitors","volume":"22","author":"S Schulman","year":"2024","journal-title":"J Thromb Haemost"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1159\/000502173","article-title":"Prothrombin complex concentrate before urgent surgery in patients treated with rivaroxaban and apixaban","volume":"143","author":"M Barzilai","year":"2020","journal-title":"Acta Haematol"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1002\/rth2.12336","article-title":"Emergencies on direct oral anticoagulants: management, outcomes, and laboratory effects of prothrombin complex concentrate","volume":"4","author":"R Bavalia","year":"2020","journal-title":"Res Pract Thromb Haemost"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1056\/NEJMoa1607887","article-title":"Andexanet alfa for acute major bleeding associated with Xa Inhibitors","volume":"375","author":"S J Connolly","year":"2016","journal-title":"N Engl J Med"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1038\/nm.3102","article-title":"A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa","volume":"19","author":"G Lu","year":"2013","journal-title":"Nat Med"},{"issue":"03","key":"ref8","first-page":"311","article-title":"High-sensitivity cardiac troponin I thresholds to identify myocardial injury after noncardiac surgery: a cohort study","volume":"39","author":"E Duceppe","year":"2023","journal-title":"Can J Cardiol"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s11239-022-02739-w","article-title":"Urgent procedures or surgeries in patients receiving oral anticoagulants: a systematic literature review","volume":"55","author":"D M Siegal","year":"2023","journal-title":"J Thromb Thrombolysis"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1182\/bloodadvances.2018024133","article-title":"Management of direct factor Xa inhibitor-related major bleeding with prothrombin complex concentrate: a meta-analysis","volume":"3","author":"S Piran","year":"2019","journal-title":"Blood Adv"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s11239-017-1506-0","article-title":"Benefits and harms of 4-factor prothrombin complex concentrate for reversal of vitamin K antagonist associated bleeding: a systematic review and meta-analysis","volume":"44","author":"M PA Brekelmans","year":"2017","journal-title":"J Thromb Thrombolysis"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"E80","DOI":"10.1503\/cjs.006318","article-title":"Venous thromboembolism in emergency general surgery patients: a single-centre retrospective cohort study","volume":"63","author":"M Yang","year":"2020","journal-title":"Can J Surg"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/TA.0000000000000517","article-title":"The excess morbidity and mortality of emergency general surgery","volume":"78","author":"J M Havens","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1056\/NEJMoa1707278","article-title":"Idarucizumab for dabigatran reversal - 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