%0 Journal Article
%T Vitamin K antagonist reversal strategies: Systematic review and network meta-analysis from the AABB.
%A Pagano MB
%A Foroutan F
%A Goel R
%A Allen ES
%A Cushing MM
%A Garcia DA
%A Hopkins CK
%A Klein K
%A Raval JS
%A Cohn CS
%J Transfusion
%V 62
%N 8
%D 08 2022
%M 35834523
%F 3.337
%R 10.1111/trf.17010
%X Anticoagulation requires urgent reversal in cases of life-threatening bleeding or invasive procedures.<BR>Network meta-analysis for comparing the safety and efficacy of warfarin reversal strategies including plasma and prothrombin complex concentrates (PCCs).<BR>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).<BR>PCCs probably provide an advantage in INR reversal compared to plasma. There was no added risk of adverse events with PCCs.