title: Reversal of anticoagulation with four-factor prothrombin complex concentrate without concurrent vitamin K (phytonadione) for urgent surgery in a patient at moderate-to-high risk for thromboembolism.
abstract: Successful vitamin K antagonist (eg, warfarin) reversal with 4-factor prothrombin complex concentrate (4F-PCC) without vitamin K (phytonadione) for emergent surgery in a patient at moderate-to-high risk for thromboembolism is reported. This approach may decrease the risk for development of thrombus, as it limits the amount of time the patient's anticoagulation is subtherapeutic. It also may increase the risk of bleeding, so patient selection is essential if this strategy is employed. Caution must be exercised to complete the procedure or surgery in the window of peak 4F-PCC effect (∼1-6 hours postinfusion).
authors: Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA Department of Pharmacy, Mercy Hospital Iowa City, Iowa City, Iowa, USA.
authors: Thomas Michael
authors: http://orcid.org/0000-0003-4218-7718
authors: TM
authors: Farley
authors: Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA.
authors: Elisha M
authors: EM
authors: Andreas
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery*; D000071576:Crush Injuries / Q000150:complications / Q000601:surgery; D004342:Drug Hypersensitivity / Q000209:etiology*; D005360:Fibula / Q000293:injuries; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery; D006801:Humans; D019934:International Normalized Ratio; D007869:Leg Injuries / Q000150:complications / Q000601:surgery; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D014812:Vitamin K / Q000009:adverse effects*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin