Warfarin-induced bleeding complications - clinical presentation and therapeutic options

Acute bleeding during oral anticoagulant therapy is a major challenge in medicine with millions of patients receiving oral anticoagulant therapy worldwide, the frequency of severe bleeding episodes ranges from 2% to 13%, according to clinical trial data. The major risk associated with the use of oral anticoagulants is haemorrhage, which might be severe or even life-threatening. Treatment decisions for the reversal of oral anticoagulation (OAC) depend on factors such as urgency of the situation, as determined by the international normalised ratios (INR), location and severity of bleeding, and indication for anticoagulation. Currently available therapeutic options for the reversal of OAC include vitamin K for non-emergency situations and fresh frozen plasma (FFP) and coagulation factor concentrates such as prothrombin complex concentrate (PCC) for urgent situations. Complete and rapid reversal of warfarin-induced bleeding can be achieved more successfully with PCC than with FFP In addition, PCC is associated with a more rapid normalisation of the INR and a better clinical outcome due to the balanced ratio of four vitamin-K-dependent clotting factors plus the coagulation inhibitors protein C and Protein S. PCC products containing four factors are the preferred option for the emergency reversal of OAC, according to some clinical treatment guidelines. Other advantages of PCC over FFP include smaller infusion volumes, no blood group testing and virus-inactivated blood product. (C) 2008 Elsevier Ltd. All rights reserved.