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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 5/2010

01.05.2010 | Review Article/Brief Review

Reversal of vitamin K antagonists prior to urgent surgery

verfasst von: Chistine Grobler, MD, Jeannie Callum, MD, Stuart A. McCluskey, MD, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 5/2010

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Abstract

Purpose

The purpose of this article is to review the effective options for the reversal of vitamin K antagonists (warfarin and it coumarin analogues) and to help identify the option best suited for the patient requiring urgent surgery.

Principal findings

Vitamin K antagonists, the mainstay in long-term anticoagulation therapy, can be reversed with the administration of vitamin K, frozen plasma (FP), recombinant factor VIIa (rFVIIa), or the recently approved four-factor prothrombin complex concentrate (PCC), Octaplex®. While there is little evidence to suggest a superiority of PCC over FP, the availability of PCC in Canada is an important therapeutic addition requiring a thorough understanding of its pharmacology and risk benefit profile for the reversal of vitamin K antagonists. The use of PCC in the management of microvascular bleeding should be limited to very specific indications and should not be indicated in the routine management of massive blood loss.

Conclusions

In order to limit the blood loss associated with surgery and the management of uncontrolled bleeding, PCC is an important addition to our therapeutic armamentarium in the reversal of vitamin K antagonists.
Fußnoten
2
The term frozen plasma is used to denote plasma frozen within 24 hours of collection in contrast to fresh frozen plasma, which is frozen within six hours of collection.
 
5
Product Monograph, Octaplex®, Octapharma Canada Inc. Control # 116440 (approved December 3, 2007).
 
6
Product Monograph, Beriplex®P/N, CSL Behring UK Limited (updated April 3, 2009).
 
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Metadaten
Titel
Reversal of vitamin K antagonists prior to urgent surgery
verfasst von
Chistine Grobler, MD
Jeannie Callum, MD
Stuart A. McCluskey, MD, PhD
Publikationsdatum
01.05.2010
Verlag
Springer-Verlag
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 5/2010
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-009-9250-3

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