Urgent reversal of warfarin with prothrombin complex concentrate: Where are the evidence-based data?

Abstract

In summary, despite the shortcomings of the Lankiewicz study [10], their observations provide additional proof of principle for the usefulness of the PCCs in the urgent reversal of warfarin-induced bleeding. Currently, this approach is empirical and is based on limited but favorable clinical observations. rFVIIa also appears to be another promising option for warfarin reversal, most likely achieved via a different mechanism. Both products appear to be superior to FFP in viral safety and rapidity of INR normalization. There is no head-to-head comparison assessing limitation of the morbidity and mortality associated with warfarin-associated intracranial bleeding [22,23]. Only future well designed, insightful, adequately powered, controlled trials will provide the data required to establish accurate risk benefit and cost-benefit perspectives on the relative usefulness of the various types of PCCs, rFVIIa, Commentary 965 and FFP for acute reversal of catastrophic bleeds because of oral anticoagulation. © 2006 International Society on Thrombosis and Haemostasis.