Prothrombin complex concentrate use for urgent warfarin reversal compared to fresh frozen plasma and recombinant factor VIIa

Hua Xin Chen, James Coons



Agents used to rapidly reverse warfarin include fresh frozen plasma (FFP), recombinant factor VIIa (rFVIIa), and prothrombin complex concentrates (PCCs). The recent approval of PCCs to the health system formulary allowed for a comparison of PCCs to the older agents FFP and rFVIIa. Additionally, limited data comparing rFVIIa and PCCs are available.


To compare the effectiveness of PCCs and FFP/rFVIIa for the rapid reversal of warfarin.


This retrospective study included hospitalized patients who received 4-factor PCC between July 1, 2013 and April 30, 2014 and those who received rFVIIa and/or FFP between October 19, 2010 and September 30, 2012. All reversals for patients receiving therapy with warfarin were included. The primary outcome was the proportion of reversals achieving INR £1.3 within 8 hours. Secondary outcomes included average INR reduction and the median time to INR £1.3.


The PCC cohort included 64 warfarin reversals. The historical cohorts included 394 reversals with FFP and 27 reversals with rFVIIa/FFP. The target INR was reached in 45.3% of PCC reversals, 10.2% of FFP-only reversals (p <0.001 vs. PCC), and 77.8% of rFVIIa/FFP reversals (p=0.004 vs. PCC). The median time to target INR for the PCC, FFP, and rFVIIa/FFP groups were 3.6h, 4.8h (p=0.17 vs. PCC), and 1.3h (p=0.002 vs. PCC), respectively.


PCC use resulted in greater hemostasis compared to FFP alone. rFVIIa use resulted in the fastest and greatest proportion of INR reduction, though a larger sample size and adverse event data are needed to recommend its use.


warfarin; reversal; hemostasis; recombinant factor VIIa; prothrombin complex concentrates

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