Rapid reversal of warfarin-associated hemorrhage in the emergency department by prothrombin complex concentrates

Ann Emerg Med. 2013 Dec;62(6):616-626.e8. doi: 10.1016/j.annemergmed.2013.05.026. Epub 2013 Jul 3.


Life-threatening warfarin-associated hemorrhage is common, with a high mortality. In the United States, the most commonly used therapies--fresh frozen plasma and vitamin K--are slow and unpredictable and can result in volume overload. Outside of the United States, prothrombin complex concentrates are often used instead; these pooled plasma products reverse warfarin anticoagulation in minutes rather than hours. This article reviews the literature relating to warfarin reversal with fresh frozen plasma, prothrombin complex concentrates, and recombinant factor VIIa and provides elements for a management protocol based on this literature.

Publication types

  • Review

MeSH terms

  • Anticoagulants / adverse effects*
  • Anticoagulants / antagonists & inhibitors
  • Blood Coagulation Factors / therapeutic use*
  • Clinical Protocols
  • Emergency Service, Hospital*
  • Factor VIIa / therapeutic use
  • Hemorrhage / chemically induced*
  • Hemorrhage / therapy
  • Humans
  • Plasma
  • Recombinant Proteins / therapeutic use
  • Warfarin / adverse effects*
  • Warfarin / antagonists & inhibitors


  • Anticoagulants
  • Blood Coagulation Factors
  • Recombinant Proteins
  • prothrombin complex concentrates
  • Warfarin
  • recombinant FVIIa
  • Factor VIIa