Comparison of prothrombin complex concentrate and vitamin K1 in oral anticoagulant reversal.
A randomised clinical trial was undertaken to compare the value of a factor II, IX, and X concentrate (Prothromplex) with intravenous vitamin K1 (2-5 mg) in reversing an overdose of oral anticoagulants. Rapid partial correction of the prothrombin time, partial thromboplastin time, and the clotting factor assays were observed with the concentrate, but these changes were not always sustained. In contrast vitamin K1 did not show any great effect at two hours but at 24 hours there was always over-correction despite the conservative dosage, prothrombin times being shorter than the therapeutic range. The prothrombin complex concentrate provides a quicker, more controlled but less sustained method of reversing the coumarin defect than vitamin K1. But there remains a significant risk of hepatitis even with a preparation for which strenuous efforts have been made to minimise this risk by screening for hepatitis B virus. The risk should be carefully considered before such concentrates are infused in non-urgent conditions.
D000925:Anticoagulants / Q000506:poisoning*; D056486:Chemical and Drug Induced Liver Injury; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D005164:Factor IX / Q000009:adverse effects / Q000627:therapeutic use; D005170:Factor X / Q000627:therapeutic use; D006801:Humans; D011041:Poisoning / Q000188:drug therapy; D011516:Prothrombin / Q000627:therapeutic use*; D011517:Prothrombin Time; D013925:Thromboplastin; D013997:Time Factors; D014812:Vitamin K / Q000627:therapeutic use*
D000925:Anticoagulants; D004338:Drug Combinations; D014812:Vitamin K; D011516:Prothrombin; D005164:Factor IX; D005170:Factor X; D013925:Thromboplastin