Vitamin K antagonist
therapy is associated with an increased
bleeding risk, and clinicians often reverse anticoagulation in patients who require emergency
surgical procedures. Current guidelines for rapid
anticoagulation reversal for emergency surgery recommend four-factor
prothrombin complex concentrate and
vitamin K coadministration. The authors reviewed the current evidence on
prothrombin complex concentrate treatment for
vitamin K antagonist reversal in the perioperative setting, focusing on comparative studies and in the context of
intracranial hemorrhage and cardiac surgery. The authors searched Cochrane Library and PubMed between January 2008 and December 2017 and retrieved 423 English-language papers, which they then screened for relevance to the perioperative setting; they identified 36 papers to include in this review.
Prothrombin complex concentrate
therapy was consistently shown to reduce international normalized ratio rapidly and control
bleeding effectively. In comparative studies with plasma,
prothrombin complex concentrate use was associated with a greater proportion of patients achieving target international normalized ratios rapidly, with improved hemostasis. No differences in thromboembolic event rates were seen between
prothrombin complex concentrate and plasma, with
prothrombin complex concentrate also demonstrating a lower risk of fluid overload events. Overall, the studies the authors reviewed support current recommendations favoring
prothrombin complex concentrate
therapy in patients requiring
vitamin K antagonist reversal before emergency surgery.