An Open-label, Randomized, Multicenter Phase IIIb Study to Assess the Efficacy, Safety and Tolerance of BERIPLEX® P/N (Kcentra) Compared With Plasma for Rapid Reversal of Coagulopathy Induced by Vitamin K Antagonists in Subjects Requiring an Urgent Surgical Procedure (BE1116_3003)

This is an interventional treatment trial for Reversal of Coagulopathy focused on measuring Anticoagulant reversal, Prothrombin Complex Concentrate, Coagulopathy, Coumarin derivatives, Emergency surgery, Invasive procedures, Vitamin K, Reversal of coagulopathy induced by coumarin derivatives, Kcentra Read More

Inclusion Criteria:

• Male and female subjects greater than or equal to 18 years,
• Subjects currently on oral vitamin K antagonist (VKA) therapy,
• An urgent surgical procedure is required within 24 hours of the start of investigational medicinal product (IMP),
• Due to the nature of the procedure, withdrawal of oral VKA therapy and infusion of plasma are also indicated to reverse the VKA effect,
• INR greater than or equal to 2 within 3 hours before start of IMP,
• Informed consent has been obtained.

Exclusion Criteria:

• Subjects requiring urgent surgical procedures where according to the surgeon's clinical judgment, an accurate estimate of blood loss is not possible (e.g., ruptured aneurysm),
• Subjects for whom administration of intravenous vitamin K and vitamin K antagonists withdrawal alone can adequately correct the subject's coagulopathy before initiation of the urgent surgical procedure,
• Administration of intravenous vitamin K more than 3 hours or administration of oral vitamin K more than 6 hours prior to infusion of IMP,
• Subjects in whom lowering INR within normal range may present an unacceptable risk for a thromboembolic complication where the INR goal is to lower but not normalize the INR because of risk of a procedure-associated stroke,
• Subjects, who despite medical management that includes close monitoring and diuretics, may not, by investigator assessment, tolerate the total volume of IMP required by the protocol,
• Expected need for additional non-study blood products before infusion of IMP (Note: Administration of packed red blood cells is not an exclusion criterion),
• Expected need for platelet transfusions or desmopressin before Day 10,
• Acute trauma for which reversal of vitamin K antagonists alone would not be expected to control or resolve an acute bleeding complication and/or control the acute bleeding event,
• Unfractionated or low molecular weight heparin use within 24 hours before randomization or potential need before completion of the procedure,
• History of thromboembolic event, myocardial infarction, unstable angina pectoris, critical aortic stenosis, cerebral vascular accident, transient ischemic attack, severe peripheral vascular disease, disseminated intravascular coagulation within 3 months of enrollment,
• Reversal of VKA therapy alone may not resolve the coagulopathy (eg, receiving a potent anti-platelet agent, i.e., clopidogrel or prasugrel, or advanced liver disease),
• Known history of antiphospholipid antibody syndrome or lupus anticoagulant antibodies,
• Suspected or confirmed serious viral or bacterial infection, e.g., meningitis, or sepsis at time of enrollment,
• Administration of whole blood, plasma, plasma fractions or platelets within 2 weeks prior to inclusion into the study (Note: Administration of packed red blood cells is not an exclusion criterion),
• Pre-existing progressive fatal disease with a life expectancy of less than 2 months,
• Known inhibitors to coagulation factors II, VII, IX, or X; or hereditary protein C or protein S deficiency; or heparin-induced, type II thrombocytopenia,
• Treatment with any other investigational medicinal product within 30 days prior to inclusion into the study,
• Presence or history of hypersensitivity to components of the study medication,
• Pregnant or breast-feeding women,
• Prior inclusion in this study or any other CSL Behring sponsored Beriplex study,

• For subjects with intracranial hemorrhage with:

  • Glasgow Coma Score <10 (see Appendix 8)
  • Modified Rankin Score > 3 prior to ICH (see Appendix 9)
  • Intracerebral hemorrhage
  • Epidural hematomas
  • Infratentorial hemorrhage
  • Subarachnoid hemorrhage (SAH) subjects with a Hunt and Hess Scale >2

  • Subdural hematomas that:

    • are judged to be an acute subdural hematoma (based on neurosurgeon review)
    • have a concurrent SAH or parenchymal contusion