Table 2.

Current guideline recommendations for reversal of vitamin K antagonist anticoagulation in patients with bleeding events or requiring surgery

Condition	Guidance
	US guidelines3,9,55,107	European guidelines6,10
Elective surgery	• Cessation of VKAs approximately 5 days before surgery	• VKAs should not be taken for 5 days prior to surgery
		• PCC should not be used to enable elective surgery
Emergency surgery		• Intravenous vitamin K should be administered in patients whose surgery can be delayed for 6–12 hours
		• In patients with life-threatening bleeding and an INR >1.5, 4F-PCC 20–40 IU/kg and intravenous vitamin K 10 mg should be administered
Non-major bleeding		• Intravenous vitamin K 1–3 mg should be administered
Major/life- threatening bleeding	• 4F-PCC 25–50 IU/kg concomitant with intravenous vitamin K 5–10 mg should be administered	• 4F-PCC 25–50 IU/kg concomitant with intravenous vitamin K 5–10 mg should be administered
	• In patients with VKA-associated ICH	• rFVIIa is not recommended for anticoagulation in this setting
	○ PCCs might be considered over FFP	• 4F-PCC is preferred over plasma
	○ If INR ≥ 1.4: intravenous vitamin K 10 mg plus 3F- or 4F-PCC should be administered

3F, 3-factor; 4F, 4-factor; FFP, fresh frozen plasma; ICH, intracranial hemorrhage; PCC, prothrombin complex concentrate; rFVIIa, activated recombinant factor VII; VKA, vitamin K antagonist