Vitamin K antagonist reversal strategies: Systematic review and network meta-analysis from the AABB

source extracted confidence: high 2026-04-09
#anticoagulants #blood-coagulation-factors #factor-ix #factor-x #fibrinolytic-agents

Vitamin K antagonist reversal strategies: Systematic review and network meta-analysis from the AABB

Pagano et al., 2022 | Transfusion | Systematic Review

Citation

Pagano Monica B, Foroutan Farid, ... Cohn Claudia S. Vitamin K antagonist reversal strategies: Systematic review and network meta-analysis from the AABB. Transfusion. 2022-Aug;62(8):1652-1661. doi:10.1111/trf.17010

Abstract

BACKGROUND: Anticoagulation requires urgent reversal in cases of life-threatening bleeding or invasive procedures. STUDY DESIGN AND METHODS: Network meta-analysis for comparing the safety and efficacy of warfarin reversal strategies including plasma and prothrombin complex concentrates (PCCs). RESULTS: 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). CONCLUSIONS: PCCs probably provide an advantage in INR reversal compared to plasma. There was no added risk of adverse events with PCCs.

Key Findings

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);

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 594
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anticoagulants
  • Blood Coagulation Factors
  • Factor IX
  • Factor X
  • Fibrinolytic Agents
  • Hemorrhage
  • Humans
  • International Normalized Ratio
  • Prothrombin
  • Retrospective Studies
  • Vitamin K
  • Warfarin

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review, Research Support, Non-U.S. Gov't, Network Meta-Analysis
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09