{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:01:07Z","timestamp":1792807267134,"version":"4.5.0"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>Long-term anticoagulation is used worldwide to prevent or treat thrombotic events. Anticoagulant therapy using vitamin K antagonists (VKAs) is well established; however, anticoagulants carry an increased risk of potentially life-threatening bleeding. In cases of bleeding or need for surgery, patients require careful management, balancing the need for rapid anticoagulant reversal with risk of thromboembolic events. Prothrombin complex concentrates (PCCs) replenish clotting factors and reverse VKA-associated coagulopathy. Two forms of PCC, 3-factor (3F-PCC) and 4-factor (4F-PCC), are available. Using PRISMA methodology, we systematically reviewed whether 4F-PCC is superior to 3F-PCC for the reversal of VKA-associated coagulopathy. Of the 392 articles identified, 48 full texts were reviewed, with 11 articles identified using criteria based on the PICOS format. Data were captured from 1,155 patients: 3F-PCC, n\u2009=\u2009651; 4F-PCC, n\u2009=\u2009504. ROBINS-I was used to assess bias. Nine studies showed international normalized ratio (INR) normalization to a predefined goal, ranging from \u22641.5 to \u22641.3, following PCC treatment. Meta-analysis of the data showed that 4F-PCC was favorable compared with 3F-PCC overall (odds ratio [OR]: 3.50; 95% confidence interval [CI]: 1.88\u20136.52, p\u2009&lt;\u20090.0001) and for patients with a goal INR of \u22641.5 or \u22641.3 (OR: 3.45; 95% CI: 1.42\u20138.39, p\u2009=\u20090.006; OR: 3.25; 95% CI: 1.30\u20138.13, p\u2009=\u20090.01, respectively). However, heterogeneity was substantial (I\n            2\u2009=\u200962%, I\n            2\u2009=\u200970%, I\n            2\u2009=\u200964%). Neither a significant difference in mortality (OR: 0.72; 95% CI: 0.42\u20131.24, p\u2009=\u20090.23) nor in thromboembolisms was reported. These data suggest that 4F-PCC is better suited than 3F-PCC for the treatment of patients with VKA-associated coagulopathy, but further work is required for a definitive recommendation.<\/jats:p>","DOI":"10.1055\/s-0042-1758653","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T23:31:50Z","timestamp":1673393510000},"page":"040-053","source":"Crossref","is-referenced-by-count":16,"title":["3-Factor versus 4-Factor Prothrombin Complex Concentrates for the Reversal of Vitamin K Antagonist-Associated Coagulopathy: A Systematic Review and Meta-analysis"],"prefix":"10.1055","volume":"123","author":[{"given":"Dorothea","family":"Puchstein","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Kork","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Sch\u00f6chl","sequence":"additional","affiliation":[{"name":"Department for Anaesthesiology and Intensive Care Medicine, AUVA Trauma Academic Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farahnaz","family":"Rayatdoost","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Grottke","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"issue":"16","key":"ref1","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1080\/14656566.2016.1241233","article-title":"An update on the pharmaceutical management of thrombosis","volume":"17","author":"B Cosmi","year":"2016","journal-title":"Expert Opin Pharmacother"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1182\/blood-2014-04-571232","article-title":"Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials","volume":"124","author":"N van Es","year":"2014","journal-title":"Blood"},{"issue":"11","key":"ref3","doi-asserted-by":"crossref","first-page":"893","DOI":"10.7326\/0003-4819-139-11-200312020-00007","article-title":"Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis","volume":"139","author":"L A Linkins","year":"2003","journal-title":"Ann Intern Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"257S","DOI":"10.1378\/chest.08-0674","article-title":"Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)","volume":"133","author":"S Schulman","year":"2008","journal-title":"Chest"},{"issue":"21","key":"ref5","doi-asserted-by":"crossref","first-page":"2689","DOI":"10.1161\/CIRCULATIONAHA.106.653048","article-title":"Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation","volume":"115","author":"E M Hylek","year":"2007","journal-title":"Circulation"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1161\/STROKEAHA.110.592907","article-title":"Cost efficiency of anticoagulation with warfarin to prevent stroke in medicare beneficiaries with nonvalvular atrial fibrillation","volume":"42","author":"C J Mercaldi","year":"2011","journal-title":"Stroke"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1055\/s-0039-1695736","article-title":"Using plasma and prothrombin complex concentrates","volume":"46","author":"J H Levy","year":"2020","journal-title":"Semin Thromb Hemost"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1213\/ANE.0000000000001188","article-title":"Prothrombin complex concentrates for bleeding in the perioperative setting","volume":"122","author":"K Ghadimi","year":"2016","journal-title":"Anesth Analg"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1160\/TH16-04-0266","article-title":"Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. 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retrospective, propensity-matched pilot study","volume":"42","author":"G M Jones","year":"2016","journal-title":"J Thromb Thrombolysis"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.ajem.2017.01.049","article-title":"Comparison of the safety and efficacy between 3-factor and 4-factor prothrombin complex concentrates for the reversal of warfarin","volume":"35","author":"J E Kuroski","year":"2017","journal-title":"Am J Emerg Med"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jcrc.2016.02.018","article-title":"Is there a difference in efficacy, safety, and cost-effectiveness between 3-factor and 4-factor prothrombin complex concentrates among trauma patients on oral anticoagulants?","volume":"33","author":"A Mangram","year":"2016","journal-title":"J Crit Care"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s12873-020-00386-z","article-title":"Propensity score 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Alltag","author":"F Bauer","year":"2019","edition":"8. Auflage edn."}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1758653.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T23:34:39Z","timestamp":1673393679000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1758653"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":41,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2023,1,10]]},"published-print":{"date-parts":[[2023,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1758653","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}