Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation

Marzia Angelo1, Bernd Gutmann1, Michele Adami1, Bernd Zagler1, Anton Zelger1, Christoph Pechlaner2, Christian J. Wiedermann1
12nd Division of Internal Medicine, Department of Internal Medicine, Central Hospital of Bolzano, Bolzano, Italy
2Division of General Internal Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria

Tóm tắt

Abstract Recommendations for urgent reversal of oral anticoagulation with vitamin K1 antagonists are largely derived from case series employing empirical dosing regimens with vitamin K1 and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR) reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to ≤ 1.6 and underwent operation without complications. Evidence on treatment of patients who present with elevated INR and who have major bleeding or need to undergo emergency surgery is based mainly on observational studies. The two elderly patients presented here underwent successful emergency surgery after their INRs had been corrected with the intravenous use of vitamin K1 in combination with prothrombin complex concentrate that was administered according to current guideline recommendations.

Từ khóa


Tài liệu tham khảo

Schulman S: Clinical practice. Care of patients receiving long-term anticoagulant therapy. N Engl J Med 2003, 349: 675-83. 10.1056/NEJMcp025373

Dentali F, Ageno W, Crowther M: Treatment of coumarin-associated coagulopathy: a systematic review and proposed treatment algorithms. J Thromb Haemost 2006, 4: 1853-63. 10.1111/j.1538-7836.2006.01986.x

Kessler CM: Urgent reversal of warfarin with prothrombin complex concentrate: where are the evidence-based data? J Thromb Haemost 2006, 4: 963-6. 10.1111/j.1538-7836.2006.01944.x

Wilkerson WR, Sane DC: Aging and thrombosis. Semin Thromb Hemost 2002, 28: 555-68. 10.1055/s-2002-36700

Pautas E, Gouin-Thibault I, Debray M, Gaussem P, Siguret V: Haemorrhagic complications of vitamin K antagonists in the elderly. Risk factors and management. Drugs Aging 2006, 23: 13-25. 10.2165/00002512-200623010-00002

Kohler M: Thrombogenicity of prothrombin complex concentrates. Thromb Res 1999, 95: S13-7. 10.1016/S0049-3848(99)00079-1

Evans G, Luddington R, Baglin T: Beriplex P/N reverses severe warfarin induced overanticoagulation immediately and completely in patients presenting with major bleeding. Br J Haematol 2001, 115: 998-1001. 10.1046/j.1365-2141.2001.03214.x

Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E: The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004, 126(3 Suppl):204S-233S. 10.1378/chest.126.3_suppl.204S

Lavenne-Pardonge E, Itegwa MA, Kalaai M, Klinkenberg G, Loncke JL, Pelgrims K, Strengers PF: Emergency reversal of oral anticoagulation through PPSB-SD: the fastest procedure in Belgium. Acta Anaesthesiol Belg 2006, 57: 121-5.

Boulis NM, Bobek MP, Schmaier A, Hoff JT: Use of factor IX complex in warfarin-related intracranial hemorrhage. Neurosurgery 1999, 45: 1113-9. 10.1097/00006123-199911000-00020

Cartmill M, Dolan G, Byrne JL, Byrne PO: Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergency. Br J Neurosurg 2000, 14: 458-61. 10.1080/02688690050175265

Fredriksson K, Norrving B, Stromblad LG: Emergency reversal of anticoagulation after intracerebral hemorrhage. Stroke 1992, 23: 972-7.

Makris M, Graves M, Phillips WS, Kitchen S, Rosendaal FR, Preston EF: Emergency oral anticogulant reversal: The relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Thromb Haemost 1997, 77: 477-80.

Yasaka M, Sakata T, Minematsu K, Naritomi H: Correction of INR by prothrombin complex concentrate and vitamin K in patients with warfarin related hemorrhagic complication. Thromb Res 2003, 108: 25-30. 10.1016/S0049-3848(02)00402-4