Individualized dosing regimen for prothrombin complex concentrate more effective than standard treatment in the reversal of oral anticoagulant therapy: An open, prospective randomized controlled trial

Aart, Lonneke van; Eijkhout, H.W.; Kamphuis, Jan S.; Dam, Marco; Schattenkerk, M. Eeftinck; Schouten, Teunis J.; Ploeger, Ben; Strengers, P. F. W.

doi:10.1016/j.thromres.2005.08.005

Cited by 142 publications

(103 citation statements)

References 25 publications

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“…Four of these, two deep vein thromboses and two non-ST elevation myocardial infarctions which were identified in a retrospective review of 58 patients, were not attributed to PCC therapy [15]. Two thrombotic strokes occurred in patients with extensive co-morbidities [16]. The first patient, a 75-year-old male, suffered from multi-infarct brain damage, longstanding hypertension, atrial fibrillation and vascular disease of the legs.…”

Section: Thrombotic Complications With Pccsmentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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Prothrombin complex concentrates (PCCs) are used mainly for emergency reversal of vitamin K antagonist therapy. Historically, the major drawback with PCCs has been the risk of thrombotic complications. The aims of the present review are to examine thrombotic complications reported with PCCs, and to compare the safety of PCCs with human fresh frozen plasma. The risk of thrombotic complications may be increased by underlying disease, high or frequent PCC dosing, and poorly balanced PCC constituents. The causes of PCC thrombogenicity remain uncertain but accumulating evidence indicates the importance of factor II (prothrombin). With the inclusion of coagulation inhibitors and other manufacturing improvements, today's PCCs may be considered safer than earlier products. PCCs may be considered preferable to fresh frozen plasma for emergency anticoagulant reversal, and this is reflected in the latest British and American guidelines. Care should be taken to avoid excessive substitution with prothrombin, however, and accurate monitoring of patients' coagulation status may allow thrombotic risk to be reduced. The risk of a thrombotic complication due to treatment with PCCs should be weighed against the need for rapid and effective correction of coagulopathy.

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Section: Thrombotic Complications With Pccsmentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

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“…G Consideration of the starting INR and the patient's weight is known to improve the efficacy of INR reversal. 44 An upper dose of 30 IUÁkg -1 and a lower dose of 8.8 IUÁkg -1 are supported by limited clinical data. 45,46 The Canadian recommendation is for 10-12 IUÁkg -1 for INR less than 3.0.…”

Section: Dosage and Efficacymentioning

confidence: 98%

Reversal of vitamin K antagonists prior to urgent surgery

Grobler

Callum

McCluskey

2010

Can J Anesth/J Can Anesth

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Purpose The purpose of this article is to review the effective options for the reversal of vitamin K antagonists (warfarin and it coumarin analogues) and to help identify the option best suited for the patient requiring urgent surgery. Principal findings Vitamin K antagonists, the mainstay in long-term anticoagulation therapy, can be reversed with the administration of vitamin K, frozen plasma (FP), recombinant factor VIIa (rFVIIa), or the recently approved four-factor prothrombin complex concentrate (PCC), OctaplexÒ. While there is little evidence to suggest a superiority of PCC over FP, the availability of PCC in Canada is an important therapeutic addition requiring a thorough understanding of its pharmacology and risk benefit profile for the reversal of vitamin K antagonists. The use of PCC in the management of microvascular bleeding should be limited to very specific indications and should not be indicated in the routine management of massive blood loss. Conclusions In order to limit the blood loss associated with surgery and the management of uncontrolled bleeding, PCC is an important addition to our therapeutic armamentarium in the reversal of vitamin K antagonists.

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“…A subsequent dose of PCC may be necessary, especially if a standard single dose was initially given. 20 Prothrombin complex concentrates may be administered by direct intravenous push, syringe pump, or minibag at the maximum infusion rate of 8 mLÁmin -1 for Beriplex and 1-3 mLÁmin -1 for Octaplex. 17,18 …”

Section: Dose Of Pccsmentioning

confidence: 99%

“…26 Frozen plasma is indicated only for the urgent reversal of warfarin therapy if PCCs are not available or are contraindicated. 7,20 Table 3 summarizes the characteristics of PCCs and FP. Similar to PCCs, the duration of effect of FP is limited by the short half-life of factor VII (approximately six hours).…”

Section: Contraindicationsmentioning

confidence: 99%

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Reversal of warfarin anticoagulation for urgent surgical procedures

Curtis

Schweitzer

Vlymen

2015

Can J Anesth/J Can Anesth

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Purpose Patients treated with warfarin for therapeutic anticoagulation present a challenge for the perioperative management of urgent and emergent surgery. Anticoagulation must be reversed prior to most surgical procedures to prevent intraoperative bleeding. The purpose of this module is to review the options for urgent reversal of warfarin anticoagulation and the indications for each reversal agent. Selection of the appropriate agent is important to reduce unnecessary complications of treatment and to achieve optimal reversal of anticoagulation. Principal findings When urgent surgery is required for patients taking warfarin, intravenous vitamin K 1 should be used for procedures that can be delayed for six to 12 hr. Vitamin K 1 results in the activation of existing clotting factors rather than requiring the synthesis of new proteins, which allows for its relatively rapid onset of action. Intravenous vitamin K 1 acts more quickly than oral administration, with reversal of anticoagulation occurring within six to 12 hr vs 18-24 hr, respectively. If surgery cannot be delayed, prothrombin complex concentrates (PCCs) should be given, and intravenous vitamin K 1 should be infused concurrently to ensure sustained reversal of anticoagulation. The duration of action of both PCCs and plasma is six hours due to the short half-life of factor VII. Prothrombin complex concentrates contain small amounts of heparin and are contraindicated in patients with heparin-induced thrombocytopenia. Plasma should be used only if PCCs are unavailable or are contraindicated. Conclusion Reversal of warfarin anticoagulation can be achieved in a safe and timely manner when the appropriate agent is selected and administered correctly. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to: 1. Identify the options for emergency reversal of warfarin anticoagulation; 2. Describe the dose, onset, and duration of action of agents that reverse warfarin anticoagulation; 3. List potential complications and contraindications of agents that reverse warfarin anticoagulation; 4. Choose the optimal agent for emergency reversal of warfarin anticoagulation, considering the timing of the operation and the risks and benefits of each agent.Despite increasing use of novel agents, warfarin remains the most widely prescribed oral anticoagulant in clinical use. A recent analysis of prescribing trends following regulatory approval for the newer agents showed that warfarin still accounted for over 75% of all the oral anticoagulants used. 1 Warfarin is indicated to reduce the risk of thromboembolic events in patients with atrial fibrillation, mechanical heart valves, and deep venous thrombosis, among other indications. Therefore, as the population ages, the use of anticoagulants, including warfarin, is projected to increase substantially.Patients treated with warfarin for therapeutic anticoagulation present a challenge for the perioperative management of urgent and emergent surgery. In order to...

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Individualized dosing regimen for prothrombin complex concentrate more effective than standard treatment in the reversal of oral anticoagulant therapy: An open, prospective randomized controlled trial

Cited by 142 publications

References 25 publications

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Reversal of vitamin K antagonists prior to urgent surgery

Reversal of warfarin anticoagulation for urgent surgical procedures

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