Prothrombin complex concentrate better than FFP for urgent warfarin reversal

Prothrombin complex concentrate better than FFP for urgent warfarin reversal

Prothrombin complex concentrate has been shown to be better than fresh frozen plasma for urgent warfarin reversal in a study published in Circulation [1]. It was a before-after study in which those who received fresh frozen plasma for urgent warfarin reversal in the emergency department and those who received prothrombin complex concentrate were compared. The primary outcome evaluated was the occurrence serious adverse events like death, ischemic stroke, myocardial infarction, heart failure, venous thromboembolism, or peripheral arterial thromboembolism occurring within 7 days.

Time to reversal of international normalized ratio, length of hospital stay, and red blood cell transfusions within 48 hours were the factors considered as secondary outcome. While the median time for reversal of INR was 11.8 hours with FFP, it was 5.8 hours with PCC. There were 149 patients in the FFP group and 165 in PCC group. While serious adverse events occurred in 19.7% of the FFP group, it occurred only in 9.7% of the PCC group.

A systematic review and meta-analysis reported in 2016 had included 5 randomized studies and 8 observational studies. Use of PCC was associated with a significant reduction in all-cause mortality compared to FFP. There was more rapid reduction in INR and less volume overload, without an increase in the risk of thromboembolic events with PCC [2]. It may be noted that using vitamin K for reversal is not ideal in these situations because it acts very slowly and re-induction of anticoagulation later is more delayed.

References

1. Michael Hickey, Mathieu Gatien, Monica Taljaard, Amiirah Aujnarain, Antonio Giulivi, Jeffrey J Perry. Outcomes of Urgent Warfarin Reversal With Frozen Plasma Versus Prothrombin Complex Concentrate in the Emergency Department. Circulation. 2013 Jul 23;128(4):360-4.
2. Chai-Adisaksopha C, Hillis C, Siegal DM, Movilla R, Heddle N, Iorio A, Crowther M. Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. A systematic review and meta-analysis. Thromb Haemost. 2016 Oct 28;116(5):879-890. doi: 10.1160/TH16-04-0266. Epub 2016 Aug 4. PMID: 27488143.