{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:21:11Z","timestamp":1787016071585,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Oral factor Xa (FXa) inhibitors are anticoagulants with no approved reversal agent for use before urgent invasive procedures. Four\u2010factor prothrombin complex concentrate (4F\u2010PCC) is used off\u2010label for this despite limited evidence regarding its effectiveness and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To determine the efficacy of 4F\u2010PCC prior to urgent invasive procedures in FXa inhibitor\u2010treated patients. Secondary aims were hemoglobin levels and transfusion requirements within 48\u2009h following the procedure, to determine the effect of treatment on anti\u2010FXa levels and to document thromboembolic events and mortality at 30\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective, single\u2010center observational study of consecutive adults receiving 4F\u2010PCC for reversal of oral FXa inhibitors before urgent invasive procedures with moderate\u2010to\u2010high bleeding risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifty\u2010nine were included in the analysis (median age 78\u2009years). Apixaban was the most frequently used anticoagulant (83.1%). 74.6% underwent urgent surgical procedures and 25.4% underwent other invasive procedures. The median 4F\u2010PCC dose was 2000\u2009units. The primary endpoint of normal or mildly abnormal hemostasis was achieved in 89.8% of patients (84.7% normal, 5.1% mildly abnormal). About 10.2% had moderately abnormal hemostasis; no patients had severe hemostatic failure. Median hemoglobin decline was 1.5\u2009g\/dL, with 8.5% of patients requiring red blood cell transfusion. In 17 patients with paired measurements, median decrease in anti\u2010FXa activity was 42%. Thromboembolic events occurred in 5.1%, and 30\u2010day mortality was 10.2%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Thromboembolic events were infrequent. These data support the use of 4F\u2010PCC for reversal of FXa inhibitors prior to urgent invasive procedures with a moderate or high bleeding risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70197","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T04:28:29Z","timestamp":1775190509000},"page":"1203-1209","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prothrombin complex concentrate for oral factor Xa inhibitor reversal prior to urgent invasive procedures"],"prefix":"10.1111","volume":"66","author":[{"given":"Mohammad","family":"Shamiea","sequence":"first","affiliation":[{"name":"Department of Medicine A Meir Medical Center  Kfar Saba Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Osnis","sequence":"additional","affiliation":[{"name":"Blood Bank Meir Medical Center  Kfar Saba 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