Advertisement

Contact Person

Dr. Elinor Switzer

Managing Editor

Phone: +49 (0)711 - 2 29 87 63
Fax: +49 (0)711 - 2 29 87 65
send an Email


Archive

Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH11-01-0052
Issue: 2011: 106/3 (Sep) pp. 389–565
Pages: 429-438

Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists

A meta-analysis

See also Editorial by Streiff

F. Dentali (1), C. Marchesi (2), M. G. Pierfranceschi (3), M. Crowther (4), D. Garcia (5), E. Hylek (6), D. M. Witt (7, 8), N. P. Clark (7), A. Squizzato (1), D. Imberti (9), W. Ageno (1)

(1) Department of Clinical Medicine, University of Insubria, Varese, Italy; (2) University of Insubria, Varese, Italy; (3) Hospital of Piacenza, Piacenza, Italy; (4) McMaster University, Hamilton, Ontario, Canada; (5) University of New Mexico School of Medicine, Albuquerque, New Mexico, USA; (6) Boston University School of Medicine, Massachusetts, USA; (7) Kaiser Permanente Colorado Clinical Pharmacy Anticoagulation Service, Aurora, Colorado, USA; (8) Kaiser Permanente Colorado Clinical Pharmacy Research Team, Aurora, Colorado, USA; (9) Hospital of Ferrara, Ferrara, Italy

Keywords

haemorrhage, Prothrombin complex concentrates, coumarins, PCC, thromboembolic complications

Summary

Prothrombin complex concentrates (PCCs) are recommended as the treatment of choice in warfarin-related coagulopathy. However, the risk of thromboembolic complications associated with their use is not well defined. We performed a meta-analysis to estimate the rate of thromboembolic complications in patients receiving vitamin K antagonists (VKAs) treated with PCCs for bleeding or before urgent surgery. Medline and Embase databases were searched. Two reviewers performed study selection and extracted data independently. Studies providing data on incidence of thromboembolic complications in VKA-treated patients were eligible for the study. Weighted mean proportion of the rate of thromboembolic complications and the mortality rate were calculated. Twenty-seven studies (1,032 patients) were included. Seven studies used 3-factor, and 20 4-factor PCCs. Twelve patients had a thromboembolic complication (weighted mean 1.4%; 95% CI 0.8–2.1), of which two were fatal. The incidence of thromboembolic events was 1.8% (95% CI 1.0–3.0) in patients treated with 4-factor PCCs, and 0.7% (95% CI 0.0–2.4) in patients treated with 3-factor PCCs. Total mortality rate was 10.6% (95% CI 5.9–16.6). In conclusion, our results suggest there is a low but quantifiable risk of thromboembolism in VKA-treated patients receiving PCCs for anticoagulation reversal. These findings should be confirmed in randomised, controlled trials.

You may also be interested in...

1.
Helmut Ostermann1, Sabine Haertel2, Sigurd Knaub2, Uwe Kalina2, Kerstin Jung2, Ingrid Pabinger3

Thromb Haemost 2007 98 4: 790-797

http://dx.doi.org/10.1160/TH07-05-0367

2.
P. Innerhofer

Hämostaseologie 2006 26 6: 3-14

3.
P. Innerhofer

Hämostaseologie 2006 26 6: 3-14