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All About Bleeding

Treatment Options for Anticoagulant Reversal

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Emergency Reversal of Warfarin

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Bleeding in an anticoagulated patient or INR levels outside the desired target range require anticoagulant reversal. A number of options are available, depending on the required reversal speed (Table 2).

Table 2. Approaches to anticoagulant reversal
Type of reversal Approach
Rapid (complete; within 10–15 minutes) Prothrombin complex concentrate (PCC) (immediate replacement of vitamin K-dependent coagulation factors) plus intravenous vitamin K (to switch on endogenous synthesis of vitamin K-dependent coagulation factors within a few hours)
Fast (partial)Fresh frozen plasma (FFP) (immediate replacement of vitamin K-dependent coagulation factors – but the correction of coagulopathy is partial)
Prompt (within 4–6 hours)Intravenous vitamin K
Slow (within 24 hours)Oral vitamin K
Very slow (3–5 days)Omit oral anticoagulation therapy (no vitamin K)

Prothrombin complex concentrates (PCCs)

Most PCCs contain all the vitamin K-dependent coagulation factors. They are the treatment of choice in several warfarin reversal guidelines when normal plasma levels of the vitamin K-dependent coagulation factors must be restored in a bleeding emergency.18

Fresh frozen plasma (FFP)

Human FFP is rich in coagulation factors and has been widely used for many years in emergency settings to reverse anticoagulation during serious bleeding. However, several important drawbacks limit the clinical use of FFP, most notably the need for large volumes to achieve adequate anticoagulation, ABO compatibility and the risk of blood-borne pathogen transmission.11 Also, FFP may be only partially effective in reversing oral anticoagulation due to low and unpredictable concentrations of vitamin K-dependent factors.11, 14, 19

Vitamin K

Vitamin K is generally recommended only as a stand-alone treatment for asymptomatic patients who have elevated INR and no obvious bleeding, but who are considered at risk of bleeding. It is important to reduce the INR within 24 hours in these patients, but without making the patient resistant to further warfarin therapy.11, 20-21

Withdrawal of Anticoagulants

Decreasing or discontinuing the vitamin K antagonist (e.g., warfarin) results in very slow reversal of anticoagulation. Most over-anticoagulated patients will return to the therapeutic range three to five days after oral anticoagulation therapy is stopped. Also, a delay of 24–36 hours is seen before the maximal rate of fall of the INR begins. As a result, simple withdrawal of therapy is not effective when urgent reversal of anticoagulation is needed.11

CSL Behring Products

Package Inserts

CSL Behring's freeze-dried prothrombin complex concentrate (PCC) product is known in various countries as:

Product Websites

Beriplex.co.uk (United Kingdom)
Kcentra.com (United States)

Not all products are available in every country. To learn what products are available in your country, visit your CSL Behring country site.


Last Updated: 5/6/2016 11:57 AM
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