What are your thoughts on 4F-PCC utilization being restricted for major bleeding or emergent high risk procedures? I am currently a pharmacist at a tertiary care center and over the past year and a half there have been multiple instances where surgeons and our clinical pharmacy team have butted heads about the use of 4F-PCC.
In one particular case: we had a patient on apixaban (for a first episode provoked DVT 3 months prior) scheduled for incision and drainage of a lower extremity abscess. The case was scheduled about three days in advance but anticoagulation was not held, the morning of the procedure we received an order for 4F-PCC with "Reversal for I&D" on the instructions field. The patients last dose was about 8 hours prior to receiving the order. The on-call clinical pharmacist contacted the surgeon, tried to get a better understanding of the situation and explained the policies approved by the medical board that restrict the use 4F-PCC. The surgeon did not accept the recommendation holding apixaban and rescheduling the procedure for a later date and demanded that we verify and compound the order.
Alternatively for intracranial hemorrhages, emergent high-risk procedures and other similar situations we do not hesitate at all to verify and prepare the medication for immediate use.
We have policies in place due to the cost and availability of 4F-PCC in our pharmacy, and sometimes I feel that when having these types of conversations with surgeons, it may come off to the provider as prioritizing cost savings over patient outcomes. Is this something that you feel when a pharmacist recommends an alternative? Are we overstepping?
I genuinely just want to hear what surgeons or other health care providers have to say and try to utilize this information to try to understand how we can potentially improve our processes.
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