Outcomes of Urgent Warfarin Reversal Using Fresh Frozen Plasma versus Prothrombin Complex Concentrate in the Emergency Department
Background—Physicians reverse patients' warfarin anticoagulation with frozen plasma or prothrombin complex concentrate. Our objective was to determine adverse event frequency following urgent reversal using frozen plasma versus the prothrombin complex concentrate Octaplex.
Methods and Results—This natural before-after retrospective cohort study in two tertiary care emergency departments (EDs) compared anticoagulation reversal between frozen plasma (utilized from September 2006-August 2008) and Octaplex (from September 2008-August 2010), without other system changes. We included adult patients on warfarin with an INR ≥1.5 and received frozen plasma or Octaplex. Our primary outcome was serious adverse events (death, ischemic stroke, myocardial infarction, heart failure, venous thromboembolism or peripheral arterial thromboembolism) within 7 days. Secondary outcomes included time to INR reversal, hospital length of stay and red blood cells transfused within 48 hours. We included 149 patients receiving frozen plasma and 165 receiving Octaplex. Incidence of serious adverse events for the frozen plasma group was 19.5% versus 9.7% for the Octaplex group (p=0.014, Relative Risk (RR) 2.0, 95% CI 1.1 to 3.5). This remained significant after adjusting for baseline history and reason for treatment (p=0.038, adjusted RR 1.85, 95% CI 1.03 to 3.3) using multivariable regression analysis. Median INR reversal was 11.8 hours using frozen plasma and 5.7 hours using Octaplex (p<0. 0001). Mean red cell transfusion was 3.2 using frozen plasma and 1.4 using Octaplex (p<0.0001).
Conclusions—Octaplex for urgent reversal of warfarin resulted in faster reversal, lower red cell transfusion requirements with fewer adverse events than frozen plasma.
- Received February 7, 2013.
- Revision received May 2, 2013.
- Accepted May 29, 2013.