Fresh Frozen Plasma versus Prothrombin Complex Concentrate for Warfarin Reversal in the Emergency Department: A Retrospective Cohort Study of Clinical Outcomes and Costs

Aim

Rapid reversal of warfarin-associated coagulopathy is a frequent challenge in emergency departments (EDs). Four-factor prothrombin complex concentrates (PCCs) correct the international normalized ratio (INR) more rapidly than fresh frozen plasma (FFP), but their clinical and economic impact in routine practice, particularly in resource-limited settings, remains uncertain. Materials and Methods: This retrospective cohort study was conducted in the ED of a tertiary university hospital. Adult warfarin-treated patients presenting with INR >1.2 and who received FFP alone or PCC (Cofact) alone for supratherapeutic INR and/or warfarin-associated bleeding were included. Clinical, laboratory, and direct product cost data were abstracted from electronic records. Primary outcomes were INR reduction (ΔINR) and achievement of target INR thresholds (≤1.5 and ≤1.8). Secondary outcomes included acute kidney injury (AKI), hospital and intensive care unit (ICU) length of stay, ED disposition, in-hospital mortality, and direct product costs. Multivariable logistic regression was used to explore independent associations.