Warfarin therapy: clotting factor concentrates may be more effective than fresh frozen plasma in decreasing INR quickly.

Clinical bottom line (level 2b)

  1. In patients requiring emergency oral anticoagulant reversal, clotting factor concentrates may decrease the INR to 1.2 more effectively than fresh frozen plasma.
Makris et al: Thrombosis and Haemostasis 1997; 77 (3): 477-480
Expires June 2003

The study

Prospective cohort study with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.
Setting: general hospital, UK

41 patients (aged range 21 to 88 years, 63% female) requiring the management of haemorrhage directly attributable to, or complicated by, oral anticoagulants, or for urgent reversal of warfarin therapy
Note:
  • non randomised - allocation to clotting factor was performed on clinical assessment with the most severely ill patients receiving clotting factor for life threatening bleeds.


    • Control Group: (n = 12, 12 analysed): fresh frozen plasma
    Experimental Group: (n = 29, 29 analysed): clotting factor concentrates
    All patients received intravenous K, 1-5 mg.
    100% followed for ?

    The evidence

  • In patients given fresh frozen plasma, the mean pre-treatment international normalised ratio (INR) was 10.2 (range 2.9 to 22). Fifteen minutes post-infusion the mean INR was 2.3 (range 1.6 to 3.8).
  • In patients given clotting factor concentrates, the mean pre-treatment INR was 5.8 (range 2.2 to 20). Fifteen minutes post-infusion, the mean INR was 1.3 (range 0.9 to 3.8).

    • Comments

    1. This small study does not provide sufficient evidence to be confident about the results.

    Citation

    1. Makris M, Greaves M, Phillips WS, et al: Emergency oral anticoagulant reversal: The relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Thrombosis and Haemostasis 1997; 77 (3): 477-480
    Contributor: Clare Wotton and Musab Hayatli, June 2000
    Reviewer: Martin Dawes

    Clinical Question.
    Patient on warfarin therapy
    Intervention or Exposure clotting factor concentrate
    Comparison fresh frozen plasma
    Outcome correction of coagulopathy