Connect
MJA
MJA

An update of consensus guidelines for warfarin reversal

Huyen A Tran, Sanjeev D Chunilal, Paul L Harper, Huy Tran, Erica M Wood and Alex S Gallus, on behalf of the Australasian Society of Thrombosis and Haemostasis
Med J Aust 2013; 198 (4): 198-199. || doi: 10.5694/mja12.10614

Summary

Please login with your free MJA account to view this article in full

  • Huyen A Tran1,2
  • Sanjeev D Chunilal2
  • Paul L Harper3
  • Huy Tran4
  • Erica M Wood2,5,6
  • Alex S Gallus7,8
  • on behalf of the Australasian Society of Thrombosis and Haemostasis

  • 1 Clinical Haematology, The Alfred Hospital, Melbourne, VIC.
  • 2 Haematology, Monash Medical Centre, Melbourne, VIC.
  • 3 Clinical Haematology, Palmerston North Hospital, Palmerston North, New Zealand.
  • 4 Haematology, Dorevitch Pathology, Melbourne, VIC.
  • 5 Diagnostic Haematology, Royal Melbourne Hospital, Melbourne, VIC.
  • 6 Monash University, Melbourne, VIC.
  • 7 Haematology, SA Pathology at Flinders Medical Centre, Adelaide, SA.
  • 8 Flinders University, Adelaide, SA.

Correspondence: huyen.tran@monash.edu

Competing interests:

A restricted educational grant from CSL Bioplasma that was administered by the ASTH enabled the Warfarin Reversal Consensus Group (WRCG) to travel to meet, develop and write these guidelines. No members of the WRCG received honoraria. Paul Harper is a Director of INR Online, an online warfarin management system, and a member of the Bayer HealthCare rivaroxaban New Zealand advisory committee. Erica Wood is a member of the Transfusion Outcomes Research Collaborative, which operates the Massive Transfusion and Critical Bleeding Registry through Monash University. CSL Limited, the manufacturers of Prothrombinex-VF, have provided financial support to this registry.

  • 1. Linkins LA, Choi PT, Douketis JD. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann Intern Med 2003; 139: 893-900.
  • 2. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141 (2 Suppl): e419S-e494S.
  • 3. Gallus AS, Baker RI, Chong BH, et al. Consensus guidelines for warfarin therapy. Recommendations from the Australasian Society of Thrombosis and Haemostasis. Med J Aust 2000; 172: 600-605. <MJA full text>
  • 4. Schulman S, Beyth RJ, Kearon C, Levine MN. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6 Suppl): 257S-298S.
  • 5. Whitlock RP, Sun JC, Fremes SE, et al. Antithrombotic and thrombolytic therapy for valvular disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141 (2 Suppl): e576S-600S.
  • 6. Connolly SJ, Ezekowitz MD, Yusuf S, et al; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139-1151.
  • 7. Granger CB, Alexander JH, McMurray JJ, et al; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981-992.
  • 8. Patel MR, Mahaffey KW, Garg J, et al; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365: 883-891.
  • 9. Eerenberg ES, Kamphuisen PW, Sijpkens MK, et al. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo-controlled, crossover study in healthy subjects. Circulation 2011; 124: 1573-1579.
  • 10. Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation 2011; 123: 2363-2372.
  • 11. Baker RI, Coughlin PB, Gallus AS, et al. Warfarin Reversal Consensus Group. Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. Med J Aust 2004; 181: 492-497. <MJA full text>
  • 12. Guyatt GH, Norris SL, Schulman S, et al. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): 53S-70S.
  • 13. Palareti G, Leali N, Coccheri S, et al. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy. Lancet 1996; 348: 423-428.
  • 14. A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin. The Stroke Prevention in Reversible Ischemia Trial (SPIRIT) Study Group. Ann Neurol 1997; 42: 857-865.
  • 15. White RH, Beyth RJ, Zhou H, Romano PS. Major bleeding after hospitalization for deep-venous thrombosis. Am J Med 1999; 107: 414-424.
  • 16. van der Meer FJ, Rosendaal FR, Vandenbroucke JP, Briët E. Bleeding complications in oral anticoagulant therapy. An analysis of risk factors. Arch Intern Med 1993; 153: 1557-1562.
  • 17. Landefeld CS, Beyth RJ. Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med 1993; 95: 315-328.
  • 18. Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369-2429.
  • 19. Harrison L, Johnston M, Massicotte MP, et al. Comparison of 5-mg and 10-mg loading doses in initiation of warfarin therapy. Ann Intern Med 1997; 126: 133-136.
  • 20. Crowther MA, Ginsberg JB, Kearon C, et al. A randomized trial comparing 5-mg and 10-mg warfarin loading doses. Arch Intern Med 1999; 159: 46-48.
  • 21. Kovacs MJ, Rodger M, Anderson DR, et al. Comparison of 10-mg and 5-mg warfarin initiation nomograms together with low-molecular-weight heparin for outpatient treatment of acute venous thromboembolism. A randomized, double-blind, controlled trial. Ann Intern Med 2003; 138: 714-719.
  • 22. Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e152S-184S.
  • 23. Watson HG, Baglin T, Laidlaw SL, et al. A comparison of the efficacy and rate of response to oral and intravenous vitamin K in reversal of over-anticoagulation with warfarin. Br J Haematol 2001; 115: 145-149.
  • 24. Soedirman JR, De Bruijn EA, Maes RA, et al. Pharmacokinetics and tolerance of intravenous and intramuscular phylloquinone (vitamin K1) mixed micelles formulation. Br J Clin Pharmacol 1996; 41: 517-523.
  • 25. Dezee KJ, Shimeall WT, Douglas KM, et al. Treatment of excessive anticoagulation with phytonadione (vitamin K): a meta-analysis. Arch Intern Med 2006; 166: 391-397.
  • 26. Fiore LD, Scola MA, Cantillon CE, Brophy MT. Anaphylactoid reactions to vitamin K. J Thromb Thrombolysis 2001; 11: 175-183.
  • 27. CSL Bioplasma. Prothrombinex-VF product information. Melbourne: CSL Limited, 2011.
  • 28. Australian Red Cross Blood Service. Blood component information: circular of information 2012. http://www.transfusion.com.au/sites/default/files/BCI%20290512%20FIN.pdf (accessed Dec 2012).
  • 29. New Zealand Blood. Frozen plama components. Blood component datasheet: plasma fresh frozen leucocyte depleted. 2010. http://www.nzblood.co.nz/Clinical-information/Transfusion-medicine/Health-professionals-medicine-datasheets/Frozen-plasma-components (accessed Dec 2012).
  • 30. Tran H, Collecutt M, Whitehead S, Salem HH. Prothrombin complex concentrates used alone in urgent reversal of warfarin anticoagulation. Intern Med J 2011; 41: 337-343.
  • 31. Chiu D, Grigg M, Levi E. Operating on patients with warfarin: simpler alternative approach [letter]. ANZ J Surg 2009; 79: 409-410.
  • 32. Crawford JH, Augustson BM. Prothrombinex use for the reversal of warfarin: is fresh frozen plasma needed [letter]? Med J Aust 2006; 184: 365-366. <MJA full text>
  • 33. Imberti D, Barillari G, Biasioli C, et al. Emergency reversal of anticoagulation with a three-factor prothrombin complex concentrate in patients with intracranial haemorrhage. Blood Transfus 2011; 9: 148-155.
  • 34. Keeling D, Baglin T, Tait C, et al; British Committee for Standards in Haematology. Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol 2011; 154: 311-324.
  • 35. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6 Suppl): 160S-198S.
  • 36. Crowther MA, Ageno W, Garcia D, et al. Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial. Ann Intern Med 2009; 150: 293-300.
  • 37. Crowther MA, Garcia D, Ageno W, et al. Oral vitamin K effectively treats international normalised ratio (INR) values in excess of 10. Results of a prospective cohort study. Thromb Haemost 2010; 104: 118-121.
  • 38. Douketis JD. Perioperative management of patients who are receiving warfarin therapy: an evidence-based and practical approach. Blood 2011; 117: 5044-5049.
  • 39. Spyropoulos AC, Turpie AG, Dunn AS, et al; REGIMEN Investigators. Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Thromb Haemost 2006; 4: 1246-1252.
  • 40. Dunn AS, Spyropoulos AC, Turpie AG. Bridging therapy in patients on long-term oral anticoagulants who require surgery: the Prospective Peri-operative Enoxaparin Cohort Trial (PROSPECT). J Thromb Haemost 2007; 5: 2211-2218.
  • 41. Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6 Suppl): 299S-339S.
  • 42. Burbury KL, Milner A, Snooks B, et al. Short-term warfarin reversal for elective surgery--using low-dose intravenous vitamin K: safe, reliable and convenient*. Br J Haematol 2011; 154: 626-634.
  • 43. Kovacs MJ, Kearon C, Rodger M, et al. Single-arm study of bridging therapy with low-molecular-weight heparin for patients at risk of arterial embolism who require temporary interruption of warfarin. Circulation 2004; 110: 1658-1663.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.