Reversal of drug-induced anticoagulation: old solutions and new problems

• Published in: Transfusion (Philadelphia, Pa.) Vol. 52; no. s1; pp. 45S - 55S
• Main Author: Dzik, Walter "Sunny"
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-05-2012
• Subjects: Anticoagulants - adverse effects; Anticoagulants - antagonists & inhibitors; Blood Coagulation Disorders - chemically induced; Blood Coagulation Disorders - therapy; Blood Coagulation Factors - pharmacology; Blood Coagulation Factors - therapeutic use; Blood Component Transfusion - methods; Hematology - methods; Hematology - trends; Hemorrhage - chemically induced; Hemorrhage - therapy; Humans; Models, Biological; Plasma - physiology; Vitamin K - pharmacology; Vitamin K - therapeutic use; Warfarin - adverse effects; Warfarin - antagonists & inhibitors
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2012.03690.x

Anticoagulant drugs are taken by millions of patients throughout the world. Warfarin has been the most widely prescribed anticoagulant for decades. In recent years, new oral anticoagulants have been approved for use, are being positioned as alternatives to warfarin, and represent an enormous market opportunity for pharmaceutical companies. Requests for urgent reversal of anticoagulants are not uncommon especially in the setting of critical bleeding. This review summarizes information on reversal of warfarin by vitamin K, plasma, prothrombin complex concentrates, and recombinant VIIa. In addition, we emphasize the lack of current evidence supporting reversibility of the new oral direct thrombin inhibitors and Factor Xa inhibitors. This review is presented to assist transfusion medicine specialists, hematologists, and other clinicians who prescribe blood components for reversal of drug‐induced anticoagulation.