Vitamin K antagonist reversal strategies: Systematic review and network meta-analysis from the AABB

Authors

Monica B. Pagano, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
Farid Foroutan, Ted Rogers Center for Heart Research, University Health Network, Toronto, Ontario, Canada, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
Elizabeth S. Allen, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
Melissa M. Cushing, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA., Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
David A. Garcia, Department of Medicine, University of Washington, Seattle, Washington, USA
Courtney K. Hopkins, Medical Director Deparment, Vitalant, Charleston, South Carolina, USA
Kimberly Klein, Department of Pathology and Laboratory Medicine, MD Anderson, University of Texas, Houston, Texas, USA
Jay S. Raval, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
Claudia S. Cohn, Department of Laboratory Medicine and Pathology, University of Minnesota WI, Minneapolis, Minnesota, USA

Document Type

Article

Publication Date

8-1-2022

Abstract

BACKGROUND: Anticoagulation requires urgent reversal in cases of life-threatening bleeding or invasive procedures.

STUDY DESIGN AND METHODS: Network meta-analysis for comparing the safety and efficacy of warfarin reversal strategies including plasma and prothrombin complex concentrates (PCCs).

RESULTS: Seven studies including 594 subjects using reversal agents plasma, 3-factor-PCC (Uman Complex and Konyne), and 4-factor-PCC (Beriplex/KCentra, Octaplex, and Cofact) met inclusion criteria. Compared with plasma, patients receiving Cofact probably have a higher rate of international normalized ratio (INR) correction (risk difference [RD] 499 more per 1000 patients, 95% confidence interval [CI], 176-761, low certainty[LC]); higher reversal of bleeding (323 more per 1000 patients, 11-344 more, LC); and fewer transfusion requirements (0.96 fewer units, 1.65-0.27 fewer, LC). Patients receiving Beriplex/KCentra probably have a higher rate of INR correction (476 more per 1000 patients, 332-609 more, LC); higher reversal of bleeding (127 more per 1000 patients, 43 fewer to 236 more); and similar transfusion requirements (0.01 fewer units, 0.31 fewer to 0.28 more, high/moderate certainty). Patients receiving Octaplex probably have a higher rate of INR correction (RD 579 more per 1000 patients, 189-825 more, LC).

CONCLUSIONS: PCCs probably provide an advantage in INR reversal compared to plasma. There was no added risk of adverse events with PCCs.

Recommended Citation

Pagano MB, Foroutan F, Goel R, Allen ES, Cushing MM, Garcia DA, Hopkins CK, Klein K, Raval JS, Cohn CS. Vitamin K antagonist reversal strategies: Systematic review and network meta-analysis from the AABB. Transfusion. 2022 Aug;62(8):1652-1661. doi: 10.1111/trf.17010. Epub 2022 Jul 14. PMID: 35834523.