Table 5.
Studies Comparing Warfarin Overanticoagulation Reversal with FFP, PCCs, rFVIIa
| Study | Number of patients |
Initial Presentation: INR ranges and Bleeding |
Intervention | Conclusion |
|---|---|---|---|---|
| Fredriksson 199232 (Case series) | 17 | 2.0–4.7 (all were bleeding) | 3 Factor PCC + vitK vs FFP + vitK | PCC has a more rapid INR reversal effect than FFP |
| Makris 199762 (RCT) | 41 | NE (NE) | PCC + vitK vs FFP + vitK | PCC was more rapid and provided for more complete INR correction than FFP |
| Boulis 199933 (RCT) | 13 | NE (all were bleeding) | FFP + 4 factor PCC (factor IX concentrate) + vitK vs. FFP + vitK | PCC added to FFP provided for more rapid INR correction |
| Cartmill 200034 (Prospective cohort) | 12 | NE (all were bleeding) | 3 Factor PCC + vitK vs FFP + vitK | PCC had faster INR correction |
| Deveras 200263 (Case series) | 13 | 1.85-NC (some were bleeding) | rFVIIa + or − vitK | Critically prolonged INR and bleeding complications were effectively treated by rFVIIa in all patients |
| Lin 200364 (Case series) | 4 | 1.9–5.6 (all were bleeding) | rFVIIa + FFP | INR normalized within 2 hours after rFVIIa administration |
| Freeman 200465 (Case series) | 7 | 1.5–5.6 (all were bleeding) | rFVIIa + or − FFP, vitK | RFVIIa added to standard treatment provided for more rapid INR reduction |
| Van Aart 200666 (RCT) | 93 | 2–22.6 (some were bleeding) | Individualized 4 Factor PCC vs normal 4 Factor PCC regimen | Individualized PCC dosing based on target INR, initial INR, and weight provides for faster INR reduction |
| Demeyere 201027 (RCT) | 40 | 1.6–5.5 (all non-bleeding) | 4 Factor PCC vs FFP | PCC had faster INR reversal than FFP, however, INR reversal was similar at one hour after intervention |
| Imberti 201143 (Prospective Cohort) | 46 | 2–9 (all were bleeding) | 3 Factor PCC + 10 mg IV vitK | 3 Factor PCC with vitK provided for rapid and safe INR correction |
| Chapman 201167 (Retrospective Cohort) | 31 | NE (NE) | PCC + FFP + vitK vs FFP + vitK | PCC added to FFP +vitK provided for more rapid INR reversal |
| Tran 201168 (Prospective Cohort) | 50 | 1.7–20 (some were bleeding) | 3 Factor PCC | 3 Factor PCC is safe and effective in INR reversal as monotherapy |
| Barillari 201269 (Retrospective cohort) | 47 | 1.56-NC (some were bleeding) | 3 Factor PCC + or − FFP, vitK, RBC | PCC was safe and effective in reversing oral anticoagulants |
RCT = randomized clinical trial; INR = international normalized ratio; IV = intravenous; FFP = fresh frozen plasma; PCCs = prothrombin complex concentrates; rFVIIa = recombinant factor VIIa; vitK = vitamin K; RBC = red blood cells; NC = not coagulable; NE = not evaluated or not reported in abstract and/or manuscript.