title: Reversal of drug-induced anticoagulation: old solutions and new problems.
abstract: Anticoagulant drugs are taken by millions of patients throughout the world. Warfarin has been the most widely prescribed anticoagulant for decades. In recent years, new oral anticoagulants have been approved for use, are being positioned as alternatives to warfarin, and represent an enormous market opportunity for pharmaceutical companies. Requests for urgent reversal of anticoagulants are not uncommon especially in the setting of critical bleeding. This review summarizes information on reversal of warfarin by vitamin K, plasma, prothrombin complex concentrates, and recombinant VIIa. In addition, we emphasize the lack of current evidence supporting reversibility of the new oral direct thrombin inhibitors and Factor Xa inhibitors. This review is presented to assist transfusion medicine specialists, hematologists, and other clinicians who prescribe blood components for reversal of drug-induced anticoagulation.
authors.affiliation: Blood Transfusion Service, J-224 Massachusetts General Hospital, Boston, Massachusetts 02114, USA. sdzik@partners.org
authors.forename: Walter Sunny
authors.initials: WS
authors.lastname: Dzik
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000037:antagonists & inhibitors*; D001778:Blood Coagulation Disorders / Q000139:chemically induced* / Q000628:therapy*; D001779:Blood Coagulation Factors / Q000494:pharmacology / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000379:methods; D006405:Hematology / Q000379:methods / Q000639:trends*; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D008954:Models, Biological; D010949:Plasma / Q000502:physiology; D014812:Vitamin K / Q000494:pharmacology / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin