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Reversal of Warfarin-Induced Excessive Anticoagulation with Recombinant Human Factor VIIa Concentrate

Ruby Anne E. Deveras, MD; and Craig M. Kessler, MD
[+] Article and Author Information

From Georgetown University Medical Center, Washington, DC.


Potential Financial Conflicts of Interest:Consultancies: R.A.E. Deveras, C.M. Kessler. Honoraria: C.M. Kessler.

Requests for Single Reprints: Ruby Anne E. Deveras, MD, Division of Hematology and Oncology, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC 20007-2197; e-mail, rad@georgetown.edu.

Current Author Addresses: Drs. Deveras and Kessler: Division of Hematology and Oncology, Georgetown University Medical Center, Lombardi Cancer Center, 3800 Reservoir Road NW, Washington, DC 20007-2197.

Author Contributions: Conception and design: R.A.E. Deveras.

Analysis and interpretation of the data: R.A.E. Deveras, C.M. Kessler.

Drafting of the article: R.A.E. Deveras.

Critical revision of the article for important intellectual content: C.M. Kessler.

Final approval of the article: C.M. Kessler.

Provision of study materials or patients: C.M. Kessler.

Collection and assembly of data: R.A.E. Deveras.


Ann Intern Med. 2002;137(11):884-888. doi:10.7326/0003-4819-137-11-200212030-00009
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Background: Bleeding associated with warfarin anticoagulation correlates directly to duration and degree of international normalized ratio (INR) elevation above the therapeutic range. Safe and rapid reversal of excessive anticoagulation is occasionally needed to treat or avoid hemorrhagic complications.

Objective: To evaluate the efficacy and safety of human recombinant factor VIIa (rFVIIa) concentrate in persons requiring rapid reversal of the effects of warfarin.

Design: Uncontrolled case series.

Setting: Academic medical center.

Patients: 13 patients with critically increased INRs requiring immediate reversal of warfarin-induced anticoagulation.

Measurements: Prothrombin time and INR were measured before and after administration of varying doses of rFVIIa.

Results: Critically prolonged INR and bleeding complications were treated successively and rapidly in all patients, regardless of rFVIIa dose (range, 15 to 90 µg/kg of body weight). Indications for use of rFVIIa included an INR greater than 10 in high-risk persons (n = 5), clinical hemorrhage (n = 4), and diagnostic or therapeutic procedures (n = 4).

Conclusion: Safe, rapid, and effective administration of rFVIIa corrects critically prolonged INRs and can avert or reverse bleeding associated with warfarin anticoagulation.

Figures

Grahic Jump Location
Figure.
The international normalized ratios (INRs) of 13 patients relative to treatment with recombinant factor VIIa.

The 0 on the x-axis represents the time at which the dose was administered. Each line represents a patient with his or her INR. The trends in INR and prothrombin time improvement were identical for all patients.

Grahic Jump Location

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Summary for Patients

A New Way To Reverse Excessive Blood Thinning from Warfarin

The summary below is from the full report titled “Reversal of Warfarin-Induced Excessive Anticoagulation with Recombinant Human Factor VIIa Concentrate.” It is in the 3 December 2002 issue of Annals of Internal Medicine (volume 137, pages 884-888). The authors are RAE Deveras and CM Kessler.

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