Emergency reversal of anticoagulant therapy

“Vitamin K antagonists are effective in the prevention and treatment of a variety of arterial and venous thrombotic disorders, but are associated with an increased risk of serious bleeding complications”, stated Marcel Levi, MD, Academic Medical Center, University of Amsterdam, the Netherlands, opening his talk.

Based on well-documented studies of patients using vitamin K antagonists, the incidence of major bleeding is 0.5%/year and the incidence of intracranial bleeding is 0.2%/year. “However, in real-life practice this incidence may be even higher,” Levi suspects. Risk factors for bleeding are the intensity of anticoagulation, the management strategy to keep the INR in the desired range, and patient characteristics. In the case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when a patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies.

“In the case of very serious or life-threatening bleeding, immediate correction of the INR is mandatory and can be achieved by the administration of vitamin K-dependent coagulation factors,” said Levi. “Theoretically, these factors are present in fresh frozen plasma: however, the amount of plasma that is required to correct the INR is very large, carries the risk of fluid overload, and will probably take hours to administer. Therefore, prothrombin complex concentrates (PCCs), containing all vitamin K-dependent coagulation factors, are more useful.”

Report by Thomas Klein, MD, MSc (Nov. 2009)