Abstract：
Anticoagulation requires urgent reversal in cases of life-threatening bleeding or invasive procedures.
Network meta-analysis for comparing the safety and efficacy of warfarin reversal strategies including plasma and prothrombin complex concentrates (PCCs).
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).
PCCs probably provide an advantage in INR reversal compared to plasma. There was no added risk of adverse events with PCCs.
Network meta-analysis for comparing the safety and efficacy of warfarin reversal strategies including plasma and prothrombin complex concentrates (PCCs).
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).
PCCs probably provide an advantage in INR reversal compared to plasma. There was no added risk of adverse events with PCCs.
摘要：
在危及生命的出血或侵入性手术的情况下，抗凝治疗需要紧急逆转。
网络荟萃分析，用于比较华法林逆转策略（包括血浆和凝血酶原复合物浓缩物（PCCs））的安全性和有效性。
七项研究，包括594名受试者使用逆转剂血浆，3因素PCC(UmanComplex和Konyne)，和4因子-PCC(Beriplex/KCentra，Octaplex,和Cofact)符合纳入标准。与等离子体相比，接受Cofact的患者可能具有更高的国际标准化比率（INR）校正率（风险差异[RD]每1000名患者中增加499，95%置信区间[CI]，176-761，低确定性[LC]）；出血逆转率更高（每1000名患者中增加323名，11-344更多，LC)；输血需求减少(减少0.96个单位，减少1.65-0.27，LC)。接受Beriplex/KCentra的患者可能有更高的INR校正率（每1000名患者中增加476名，332-609更多，LC）；出血逆转率更高（每1000名患者中增加127名，少43到多236)；以及类似的输血要求(少0.01个单位，0.31少到0.28多，高/中等确定性）。接受Octaplex的患者可能有更高的INR校正率（每1000名患者中RD为579，189-825更多，LC)。
与血浆相比，PCC可能在INR逆转方面具有优势。PCCs没有增加不良事件的风险。
网络荟萃分析，用于比较华法林逆转策略（包括血浆和凝血酶原复合物浓缩物（PCCs））的安全性和有效性。
七项研究，包括594名受试者使用逆转剂血浆，3因素PCC(UmanComplex和Konyne)，和4因子-PCC(Beriplex/KCentra，Octaplex,和Cofact)符合纳入标准。与等离子体相比，接受Cofact的患者可能具有更高的国际标准化比率（INR）校正率（风险差异[RD]每1000名患者中增加499，95%置信区间[CI]，176-761，低确定性[LC]）；出血逆转率更高（每1000名患者中增加323名，11-344更多，LC)；输血需求减少(减少0.96个单位，减少1.65-0.27，LC)。接受Beriplex/KCentra的患者可能有更高的INR校正率（每1000名患者中增加476名，332-609更多，LC）；出血逆转率更高（每1000名患者中增加127名，少43到多236)；以及类似的输血要求(少0.01个单位，0.31少到0.28多，高/中等确定性）。接受Octaplex的患者可能有更高的INR校正率（每1000名患者中RD为579，189-825更多，LC)。
与血浆相比，PCC可能在INR逆转方面具有优势。PCCs没有增加不良事件的风险。
