Although warfarin is a common anticoagulant used to prevent blood clots and strokes, it is associated with major bleeding episodes that occasionally need to be stopped quickly. Urgent surgery patients who are taking warfarin also need the anticoagulant effects of warfarin to be reversed quickly, which is accomplished by either (1) transfusing fresh frozen plasma or (2) giving prothrombin complex concentrates. A recent systematic review and meta-analysis incorporating 13 studies compared the clinical outcomes of both strategies for urgent warfarin reversal. Compared to patients who received fresh frozen plasma, patients treated with prothrombin complex concentrates had a significant reduction in all-cause mortality (odds ratio = 0.56; 95% CI, 0.37—0.84; p=0.0006), faster international normalized ratio reduction and correction, and reduced volume overload. Many of the included studies were at moderate or serious risk of bias, thus further research is needed to confirm these conclusions.
- 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;116.