Aim: Optimal dosing of four-factor prothrombin complex concentrate (4F-PCC, Beriplex) for direct oral anticoagulant (DOAC) reversal remains uncertain. Weight-based dosing is theoretically individualised but operationally challenging, while fixed-dose regimens may offer practical advantages. The objective of this study was to compare weight-based versus fixed-dose Beriplex among older adults requiring emergency anticoagulation reversal, evaluating dosing variability, laboratory reversal, time metrics, and clinical outcomes.
Methods: Retrospective cohort of patients ≥65 years receiving Beriplex for major bleeding or urgent procedural intervention. Weight-based dosing era: Aug–Dec 2024; fixed-dose era: Aug–Oct 2025. Outcomes included thromboembolism, rebleeding, ICU admission, mortality, laboratory results, transfusion requirements, and timing intervals.
Results: Forty-five patients were included (36 weight-based; 9 fixed-dose). Demographics were similar across groups without significant differences in age (P=.072), frailty (P=.809), anticoagulation indication (P=.715), or anticoagulant type (P=.786). Weight-based dosing demonstrated substantial IU/kg variability (20–50 IU/kg) and 33% missing weights. Fixed-dose PCC showed consistent IU/kg exposure (20–37 IU/kg). Clinical outcomes did not differ significantly: thromboembolism (P=1.000), rebleeding (P=.566), ICU admission (P=.169), mortality (P=.323). Laboratory correction was similar across groups, with no significant differences except for post-reversal creatinine (higher in weight-based group; P=.0066).
Conclusions: Fixed-dose Beriplex achieved comparable biochemical correction and clinical outcomes to weight-based PCC while reducing dosing variability and operational barriers. Fixed-dose PCC appears safe, effective, and more practical for emergency anticoagulation reversal in older adults.