PCCs for PharmDs
Highlights
- The Inherent Inar Effect of F F Por Or Vitam in K So Kinnow
Summary:
F f por or vitam in k so kinnow, what are those with younow reversing anti coagulation? There's a risk of volume overloading some patients. There's infectious concerns. And then overall, once pc c came out and they actually compared them against each other, f f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. nowadays it's kind of an inferior product.
Transcript:
Speaker 1
So back in the day, the only oral anti quagu we had was war friend. So reversal was just simple, vidam j, plus or minus the edition of f eften, depending on msimerio wars.
Speaker 2
Now the kind of, the, the old adage says, if if it's not broke, don't fix it. So a, the in inherent kind of next question is, there's got to be some limitations with using f f por or vitam in k so kinnow, what are those with younow reversing anti coagulation?
Speaker 1
Ye, so once in order, it's ordered, it takes a while its actiol to get to the patient, to have to be matched a blood type and then sentto frozen. You have to allow time for i to tha, to be able to be administered. There's a risk of volume overloading some patients. And you get the fun acronims like trolley and tako. There's infectious concerns. And then overall, once pc c came out and they actually compared them against each other, f f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. So, you know, nowadays it's kind of an inferior product. (Time 0:03:26)
- The Inherent Inar Effect of F F Por Or Vitam in K So Kinnow
Summary:
F f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. The more you give, the less actualy inar reduction you get. And that's probably why, in the case centru approval study, they set their n or target at one point three,. knowing beforehand that f f p is probably never going to get there.
Transcript:
Speaker 1
Ye, so once in order, it's ordered, it takes a while its actiol to get to the patient, to have to be matched a blood type and then sentto frozen. You have to allow time for i to tha, to be able to be administered. There's a risk of volume overloading some patients. And you get the fun acronims like trolley and tako. There's infectious concerns. And then overall, once pc c came out and they actually compared them against each other, f f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. So, you know, nowadays it's kind of an inferior product.
Speaker 2
Do you think the intrinsic inar of f f p kind of contributes to the lower effectiveness compared to the four factor pc c?
Speaker 1
So when you give, you know, f f p you get, the more you give, the less actualy inar reduction you get. So, you know, if you give a few units, you can get, you know, the ionar down a coupleof points. But the more you give, the decrease you get is even less and less. So you would need just an absurd amount of f f p to actually get someone down to go like one point four. And that's probably why, in the case centru approval study, they set their n or target at one point three, knowing beforehand that f f p is probably never going to get there.
Speaker 2
He adtd in hins hide a really, really smart, kind of a research ind point there. (Time 0:03:56)
- Dosage Stimulus
Summary:
A unit of f f p has about 250 units of factor nine in it, one to two thousand units of pc cis like four to six units. This is probably a good starting dos tirbuting news por bactor, pc c and trama. Ye. this is becoming more common. Unfortunately, some of the literature out there isn't super helpful. The same group in 20 12 and 20 14, they were using three factor pc c and were using 25 unuts for kilo. Both studies showed decreased blood product administration and faster time to ie on or correction. So you kind of need to go at it with a fixed dose approach, kind of.
Transcript:
Speaker 1
Yes, this is becoming more common. Unfortunately, some of the literature out there isn't super helpful. The same group in 20 12 and 20 14, they were using three factor pc c and were using 25 unuts for kilo. Both studies showed decreased blood product administration and faster time to ie on or correction. So that's good. But then in 20 18, there was a study with four factor pc c. Again, they showed that it was beneficial, faster time to ieonour correction and things like tht. But they didn't report anything about the dosesta they were using. So since most institutions don't have three factor, we have four factor, we kind of aren't really sure what we should be dosing at. But, you know, considering that a unit of f f p has about 250 units of factor nine in it, one to two thousand units of pc cis like four to six units of f f p. So, you know, somewhere in that one to two thousand units may be 25 units for keel is probably a good starting dos tirbuting news por bactor, pc c and trama.
Speaker 2
And because you and your un oure giving it for that kind of vindication, it's kind of irrespective of what their i an ar is. So you kind of need to go at it with a fixed dose approach, kind of. So i think that's really good, really good advice right there, kind of comparing the units in in f f p to the pc c products.
Speaker 1
Now, you're not trying to like, completely replace all the f f p must trama people, they still need the volume from the f f p. So you're just trying to get some man, get it in quicker, or get it working quicker, and then you neel th f f p that youre giing later, kind of catch up and sow on the gaps.
Speaker 2
It kind of start working right away. As as you know, all the things you talked about with f f p, kind of limitations really. You wait for those.
Speaker 1
Ye. (Time 0:11:42)
- Fixed Dose Ccentra Dosing
Summary:
Weight based versus fixed dose k centra for orporin reversal. Patients greater than 95 kilos were more likely to fail the fixed dose regimen. Study also found if people had a base line iron ar greater than ten, there was a ten time higher failure risk.
Transcript:
Speaker 2
So let's focus on c centra, i knr, four factor picte products for a minute. I think the scorching hot research topic here is in a weight based versus fixed dose k centra for orporin reversal. And for those who may be less familiar, when we say weight base kcentra, it's referring to the package insert dosing, which is o based on the patient's weight in kilograms, and the i and r upon presentation. So it varies anywhere from 25 to 50 units per kilo. I'm depending on that i and r, with a weight cap at a hundred kilos. So i think the first question here is whether or not you use or believe in fixed dose ccentra. And if yes, kind of, what's your standard? Am fixed dose ccentra dosing?
Speaker 1
So, yes, i am a believer in fixed dose. And our starting dose is 15 hundred units for everybody.
Speaker 2
Now does that if yo mention 15 hundred units for for everybody, says, does the fixed dose amount, you know, ever change?
Speaker 1
So all the good literature that's out there right now does not change. However, i actuallyi my protocal, we do change. So for patients with a total ody weight over a hundred kilograms, or if their base line ian or s greater than seven point five, or if they hav intrpanal hemorrhage, we actually increased the dose to two thousand units. So that body weight comparison was from a study by klin. And they did a post hack analysis, which showed patients greater than 95 kilos were more likely to fail the fixed dose regimen. And then as terms of the i and r clime that stame stream, study also found if people had a base line iron ar greater than ten, there was a ten time higher failure (Time 0:13:21)
- The Dosing Is Easier
Summary:
Using a fixed dose regiment of cacentra, it's going to save a lot of money. It's about a thousand dollars less im using the fixed dose protocol. The dosing is easier. And then last thing es, potentially less complications with the lower dosing.
Transcript:
Speaker 2
But for those of us who may an only used weight base case centro or maybe having a hard time convincing now the e d or i c u teams to start using a fixed dose approach, would you say? Or some advantages to using a fixed dose regiment of cacentra?
Speaker 1
Yes, i men right off the back, it's going to save a lot of money. No, cacentra is not cheap. I'm three or four studies now that have come out of showin to compare cost per patient. It's about a thousand dollars less im using the fixed dose protocol. The dosing is easier. I'm especially use to 15 hundred units for than having to get a base line a r and figure out their body weight and things like that. Ah, some studies have shown a reduced time to administration, as you don't technically have to wait for a base line r if you know their bleeding and the labs or mat you can just go ahead and give a dose. And then last thing es, potentially less complications with the lower dosing. So there's a case report id 20 16 by zemrack, and they showed or the patients in their system that got a dose between 35 and 50 units per keelo, they had a 15 % complication rate. But when they looked at the lower dosing, between 15 and 25 units perculo, they didn't have a single complication. So a yo, given someone 50 units per celo with deflinge, increase the risk for no thramboan balan complication when you're given someone more the 20 to 25 range. (Time 0:15:39)
PCCs for PharmDs
Highlights
- The Inherent Inar Effect of F F Por Or Vitam in K So Kinnow
Summary:
F f por or vitam in k so kinnow, what are those with younow reversing anti coagulation? There's a risk of volume overloading some patients. There's infectious concerns. And then overall, once pc c came out and they actually compared them against each other, f f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. nowadays it's kind of an inferior product.
Transcript:
Speaker 1
So back in the day, the only oral anti quagu we had was war friend. So reversal was just simple, vidam j, plus or minus the edition of f eften, depending on msimerio wars.
Speaker 2
Now the kind of, the, the old adage says, if if it's not broke, don't fix it. So a, the in inherent kind of next question is, there's got to be some limitations with using f f por or vitam in k so kinnow, what are those with younow reversing anti coagulation?
Speaker 1
Ye, so once in order, it's ordered, it takes a while its actiol to get to the patient, to have to be matched a blood type and then sentto frozen. You have to allow time for i to tha, to be able to be administered. There's a risk of volume overloading some patients. And you get the fun acronims like trolley and tako. There's infectious concerns. And then overall, once pc c came out and they actually compared them against each other, f f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. So, you know, nowadays it's kind of an inferior product. (Time 0:03:26)
- The Inherent Inar Effect of F F Por Or Vitam in K So Kinnow
Summary:
F f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. The more you give, the less actualy inar reduction you get. And that's probably why, in the case centru approval study, they set their n or target at one point three,. knowing beforehand that f f p is probably never going to get there.
Transcript:
Speaker 1
Ye, so once in order, it's ordered, it takes a while its actiol to get to the patient, to have to be matched a blood type and then sentto frozen. You have to allow time for i to tha, to be able to be administered. There's a risk of volume overloading some patients. And you get the fun acronims like trolley and tako. There's infectious concerns. And then overall, once pc c came out and they actually compared them against each other, f f p is just not as good. You don't get as much of an inar reduction effect, and it doesn't last as long as pc c. So, you know, nowadays it's kind of an inferior product.
Speaker 2
Do you think the intrinsic inar of f f p kind of contributes to the lower effectiveness compared to the four factor pc c?
Speaker 1
So when you give, you know, f f p you get, the more you give, the less actualy inar reduction you get. So, you know, if you give a few units, you can get, you know, the ionar down a coupleof points. But the more you give, the decrease you get is even less and less. So you would need just an absurd amount of f f p to actually get someone down to go like one point four. And that's probably why, in the case centru approval study, they set their n or target at one point three, knowing beforehand that f f p is probably never going to get there.
Speaker 2
He adtd in hins hide a really, really smart, kind of a research ind point there. (Time 0:03:56)
- Dosage Stimulus
Summary:
A unit of f f p has about 250 units of factor nine in it, one to two thousand units of pc cis like four to six units. This is probably a good starting dos tirbuting news por bactor, pc c and trama. Ye. this is becoming more common. Unfortunately, some of the literature out there isn't super helpful. The same group in 20 12 and 20 14, they were using three factor pc c and were using 25 unuts for kilo. Both studies showed decreased blood product administration and faster time to ie on or correction. So you kind of need to go at it with a fixed dose approach, kind of.
Transcript:
Speaker 1
Yes, this is becoming more common. Unfortunately, some of the literature out there isn't super helpful. The same group in 20 12 and 20 14, they were using three factor pc c and were using 25 unuts for kilo. Both studies showed decreased blood product administration and faster time to ie on or correction. So that's good. But then in 20 18, there was a study with four factor pc c. Again, they showed that it was beneficial, faster time to ieonour correction and things like tht. But they didn't report anything about the dosesta they were using. So since most institutions don't have three factor, we have four factor, we kind of aren't really sure what we should be dosing at. But, you know, considering that a unit of f f p has about 250 units of factor nine in it, one to two thousand units of pc cis like four to six units of f f p. So, you know, somewhere in that one to two thousand units may be 25 units for keel is probably a good starting dos tirbuting news por bactor, pc c and trama.
Speaker 2
And because you and your un oure giving it for that kind of vindication, it's kind of irrespective of what their i an ar is. So you kind of need to go at it with a fixed dose approach, kind of. So i think that's really good, really good advice right there, kind of comparing the units in in f f p to the pc c products.
Speaker 1
Now, you're not trying to like, completely replace all the f f p must trama people, they still need the volume from the f f p. So you're just trying to get some man, get it in quicker, or get it working quicker, and then you neel th f f p that youre giing later, kind of catch up and sow on the gaps.
Speaker 2
It kind of start working right away. As as you know, all the things you talked about with f f p, kind of limitations really. You wait for those.
Speaker 1
Ye. (Time 0:11:42)
- Fixed Dose Ccentra Dosing
Summary:
Weight based versus fixed dose k centra for orporin reversal. Patients greater than 95 kilos were more likely to fail the fixed dose regimen. Study also found if people had a base line iron ar greater than ten, there was a ten time higher failure risk.
Transcript:
Speaker 2
So let's focus on c centra, i knr, four factor picte products for a minute. I think the scorching hot research topic here is in a weight based versus fixed dose k centra for orporin reversal. And for those who may be less familiar, when we say weight base kcentra, it's referring to the package insert dosing, which is o based on the patient's weight in kilograms, and the i and r upon presentation. So it varies anywhere from 25 to 50 units per kilo. I'm depending on that i and r, with a weight cap at a hundred kilos. So i think the first question here is whether or not you use or believe in fixed dose ccentra. And if yes, kind of, what's your standard? Am fixed dose ccentra dosing?
Speaker 1
So, yes, i am a believer in fixed dose. And our starting dose is 15 hundred units for everybody.
Speaker 2
Now does that if yo mention 15 hundred units for for everybody, says, does the fixed dose amount, you know, ever change?
Speaker 1
So all the good literature that's out there right now does not change. However, i actuallyi my protocal, we do change. So for patients with a total ody weight over a hundred kilograms, or if their base line ian or s greater than seven point five, or if they hav intrpanal hemorrhage, we actually increased the dose to two thousand units. So that body weight comparison was from a study by klin. And they did a post hack analysis, which showed patients greater than 95 kilos were more likely to fail the fixed dose regimen. And then as terms of the i and r clime that stame stream, study also found if people had a base line iron ar greater than ten, there was a ten time higher failure (Time 0:13:21)
- The Dosing Is Easier
Summary:
Using a fixed dose regiment of cacentra, it's going to save a lot of money. It's about a thousand dollars less im using the fixed dose protocol. The dosing is easier. And then last thing es, potentially less complications with the lower dosing.
Transcript:
Speaker 2
But for those of us who may an only used weight base case centro or maybe having a hard time convincing now the e d or i c u teams to start using a fixed dose approach, would you say? Or some advantages to using a fixed dose regiment of cacentra?
Speaker 1
Yes, i men right off the back, it's going to save a lot of money. No, cacentra is not cheap. I'm three or four studies now that have come out of showin to compare cost per patient. It's about a thousand dollars less im using the fixed dose protocol. The dosing is easier. I'm especially use to 15 hundred units for than having to get a base line a r and figure out their body weight and things like that. Ah, some studies have shown a reduced time to administration, as you don't technically have to wait for a base line r if you know their bleeding and the labs or mat you can just go ahead and give a dose. And then last thing es, potentially less complications with the lower dosing. So there's a case report id 20 16 by zemrack, and they showed or the patients in their system that got a dose between 35 and 50 units per keelo, they had a 15 % complication rate. But when they looked at the lower dosing, between 15 and 25 units perculo, they didn't have a single complication. So a yo, given someone 50 units per celo with deflinge, increase the risk for no thramboan balan complication when you're given someone more the 20 to 25 range. (Time 0:15:39)