A Comprehensive Review on Medication Used for Warfarin Reversal

Warfarin sodium as an anticoagulant, is widely used for the prevention and treatment of venous and arterial thrombosis. As a vitamin K antagonist, warfarin effectively decreases the hepatic production of clotting factors II, VII, IX, and X, along with proteins C and S. While anticoagulants such as warfarin have well-established indications, they are also associated with few side effects such as haemorrhage. Many patients receiving vitamin K antagonists have an International Normalized Ratio (INR) higher than the target of 2.0 to 3.0 for over 50% of the time, which is followed with increasing risk of bleeding. In this situation the clinical need for emergency reversal of anticoagulation is necessary. There are a number of potential treatment options for anticoagulant reversal, including administration of vitamin K (oral or intravenous), human plasma products [for example, Fresh Frozen Plasma (FFP)], prothrombin complex concentrates (PCCs); concentrates that contain coagu-lation factors II, VII, IX and X), or single coagulation factors such as activated re-combinant factor VII (rFVIIa). The aim of this paper was to conduct a review of the medical literature and summarize the advantages and risks of the available treatment options for reversing warfarin anticoagulation in patients receiving warfarin. Keywords: Warfarin, Warfarin reversal, Vitamin K, FFP, PCC, rFVIIa