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EDUCATION IN THE MANAGEMENT OF BLEEDING

A practical, evidence-based guide for front-line physicians on how to Treat the Bleed

My bleeding patient on Warfarin has a history of recent thrombosis. Are PCCs still appropriate?

Yes, but it depends on the comparison of the risk (clot severity, location, timing) versus the benefit (bleed severity, treatability).

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Therefore:

Consultation with a hematologist/thrombosis expert should be made.

  • If the decision for reversal is made, PCCs should be administered given increased efficacy and no difference in thrombosis risk compared to plasma. Thrombosis risks in different meta-analyses for warfarin reversal in patients who received PCC or plasma and vitamin K are reported to be < 5%.

References:

  1. Kearon, C., & Akl, E. A. (2014). Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood, 123(12), 1794-1801.
  2. Brekelmans MPA, Ginkel KV, Daams JG, et al. Benefits and harms of 4-factor prothrombin complex concentrate for reversal of vitamin K antagonist associated bleeding: a systematic review and meta-analysis. Journal of Thrombosis and Thrombolysis 2017;44: 118-29.
  3. Chai-Adisaksopha C, Hillis C, Siegal DM, et al. Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. A systematic review and meta-analysis. Thromb Haemost. 2016;116:879-90.
  4. Dentali F, Marchesi C, Pierfranceschi MG, et al. Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists. Thromb Haemost 2011;106: 429-38.
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A practical, evidence-based guide for front-line physicians on how to treat acquired bleeding