{Reference Type}: Journal Article
{Title}: Vitamin K antagonist reversal strategies: Systematic review and network meta-analysis from the AABB.
{Author}: Pagano MB;Foroutan F;Goel R;Allen ES;Cushing MM;Garcia DA;Hopkins CK;Klein K;Raval JS;Cohn CS;
{Journal}: Transfusion
{Volume}: 62
{Issue}: 8
{Year}: 08 2022
{Factor}: 3.337
{DOI}: 10.1111/trf.17010
{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.