The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

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

Ruby Anne E. Deveras, MD; and Craig M. Kessler, MD
[+] Article, Author, and Disclosure 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
Text Size: A A A

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.


Grahic Jump Location
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




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

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.


Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.