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Thromb Haemost 2016; 116(05): 879-890
DOI: 10.1160/TH16-04-0266
Coagulation and Fibrinolysis
Schattauer GmbH

Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal A systematic review and meta-analysis

Chatree Chai-Adisaksopha
1   Department of Medicine, McMaster University, Canada
2   Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada
,
Christopher Hillis
1   Department of Medicine, McMaster University, Canada
3   Department of Oncology, McMaster University, Canada
,
Deborah M. Siegal
1   Department of Medicine, McMaster University, Canada
,
Ron Movilla
1   Department of Medicine, McMaster University, Canada
,
Nancy Heddle
1   Department of Medicine, McMaster University, Canada
,
Alfonso Iorio
1   Department of Medicine, McMaster University, Canada
2   Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada
,
Mark Crowther
1   Department of Medicine, McMaster University, Canada
2   Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada
› Author Affiliations
Further Information

Publication History

Received: 04 April 2016

Accepted after major revision: 22 June 2016

Publication Date:
11 November 2017 (online)

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Summary

Urgent reversal of warfarin is required for patients who experience major bleeding or require urgent surgery. Treatment options include the combination of vitamin K and coagulation factor replacement with either prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). However, the optimal reversal strategy is unclear based on clinically relevant outcomes. We searched in MEDLINE, EMBASE and Cochrane library to December 2015. Thirteen studies (5 randomised studies and 8 observational studies) were included. PCC use was associated with a significant reduction in all-cause mortality compared to FFP (OR= 0.56, 95 % CI; 0.37–0.84, p=0.006). A higher proportion of patients receiving PCC achieved haemostasis compared to those receiving FFP, but this was not statistically significant (OR 2.00, 95 % CI; 0.85–4.68). PCC use was more likely to achieve normalisation of international normalised ratio (INR) (OR 10.80, 95 % CI; 6.12–19.07) and resulted in a shorter time to INR correction (mean difference –6.50 hours, 95 %CI; –9.75 to –3.24). Red blood cell transfusion was not statistically different between the two groups (OR 0.88, 95 % CI: 0.53–1.43). Patients receiving PCC had a lower risk of post-transfusion volume overload compared to FFP (OR 0.27, 95 % CI; 0.13–0.58). There was no statistically significant difference in the risk of thromboembolism following administration of PCC or FFP (OR 0.91, 95 % CI; 0.44–1.89). In conclusion, as compared to FFP, the use of PCC for warfarin reversal was associated with a significant reduction in all-cause mortality, more rapid INR reduction, and less volume overload without an increased risk of thromboembolic events.

Supplementary Material to this article is available online at www.thrombosis-online.com.

Keywords

Factor concentrates - haemorrhage - warfarin - mortality - plasma

 

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