Outcomes of urgent warfarin reversal with frozen plasma versus prothrombin complex concentrate in the emergency department.

Hickey M, Gatien M, Taljaard M, Aujnarain A, Giulivi A, Perry JJ
Circulation 2013;128:360-364.
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Review by : M. Levi
NATA Review

The most important complication of treatment with warfarin is hemorrhage, which may be serious, may cause long-term debilitating disease, or may even be life-threatening. If severe bleeding occurs or if a patient needs to undergo an urgent invasive procedure, such as emergency surgery, it may be required to reverse the anticoagulant effect of warfarin. Immediate reversal can be achieved by prothrombin complex concentrate or fresh frozen plasma, both of which contain the deficient coagulation factors.

Immediate warfarin reversal with fresh frozen plasma or prothrombin complex concentrate were compared in a retrospective cohort study focusing on clinically relevant outcomes. The authors showed that prothrombin complex concentrate treatment was associated with a significantly lower incidence of adverse events, much quicker reversal of INR, and reduced transfusion rates. This is an interesting and important observation, which is relevant as prothrombin complex concentrate becomes increasingly available worldwide for reversal of warfarin anticoagulation. Interestingly, initial studies have shown that prothrombin complex concentrates may also be effective for reversal of novel oral anti-factor Xa agents, a situation in which plasma is probably less effective.

– Marcel Levi