The problem of hemorrhagic syndrome in its treatment with vitamin K antagonists (a review of literature)


Cite item

Full Text

Abstract

Vitamin K antagonists (warfarin, syncumar, phenylin, etc.) are commonly used to treat and prevent thrombotic diseases. The risk for varying degrees of hemorrhagic syndrome (intracranial hemorrhage in particular) is the most important problem in the use of drugs from this group. The rapid neutralization of the effects of used anticoagulants, which is verified by correcting the international normalized ratio (INR), is required in these cases and when emergency surgical interventions are needed. Transfusions of prothrombin complex concentrates (PCCs) in combination of vitamin K preparations are optimal for this purpose. The reason for the rational use of PCCs to promptly correct INR is the balanced composition of this transfusion medium (a combination of blood coagulation factors and biological anticoagulants). This regimen for emergency correction of INR minimizes the risk of thrombotic events.

Full Text

Проблема геморрагического синдрома при лечении антагонистами витамина К. - Аннотация. Для лечения и профилактики тромботических заболеваний часто используются препараты - антагонисты витамина К (варфарин, синкумар, фенилин и др.). Важнейшей проблемой при использовании препаратов этой группы является риск развития различной степени тяжести геморрагического синдрома (особенно внутричерепных кровотечений). В подобных случаях, а также при необходимости срочных хирургических вмешательств требуется быстрая нейтрализация действия применяемых антикоагулянтов, выверяемая по коррекции международного нормализованного отношения (МНО). Оптимальным для этой цели представляется применение трансфузий концентратов протромбинового комплекса (КПК) в сочетании с введением препаратов витамина К. Причиной рациональности применения КПК для срочной коррекции МНО является сбалансированность состава этой трансфузионной среды (сочетание факторов свертывания крови с биологическими антикоагулянтами). Такая схема экстренной коррекции МНО сводит к минимуму риск развития тромботических осложнений.
×

References

  1. Vigué B. Bench-to-bedside review: Optimising emergency reversal of vitamin K antagonists in severe haemorrhage - from theory to practice. Crit Care 2009; 13 (2): 209-218.
  2. Linn A.J., Desilva C., Peeters-Asdourian C. Thromboembolic stroke: a rare complication associated with periprocedural management of an epidural steroid injection. Pain Physician 2009; 12 (1): 159-162.
  3. Кропачева Е.С., Панченко Е.П. Практические аспекты терапии варфарином. Рус мед журн 2005; 13 (19): 1246-1249.
  4. Khoshbin E., Tang A. Use of contrast-enhanced computed tomography for management of a late-onset spontaneous massive chest wall hematoma. Gen Thorac Cardiovasc Surg 2011; 59 (5): 380-381.
  5. Bendel S.D., Bona R., Baker W.L. Dabigatran: an oral direct thrombin inhibitor for use in atrial fibrillation. Adv Ther 2011; 26. [Epub ahead of print].
  6. Rolfe S., Papadopoulos S., Cabral K.P. Controversies of anticoagulation reversal in life-threatening bleeds. J Pharm Pract 2010; 23 (3): 217-225.
  7. Guest J.F., Watson H.G., Limaye S. Modeling the cost-effectiveness of prothrombin complex concentrate compared with fresh frozen plasma in emergency warfarin reversal in the United kingdom. Clin Ther 2010; 32 (14): 2478-2493.
  8. Gumulec J., Kessler P., Procházka V. et al. Bleeding complications of anticoagulant therapy. Vnitr Lek 2009; 55 (3): 277-289.
  9. Testerman G.M., Shilad S., George K.J. Rapid warfarin reversal with factor VIIa in an elderly trauma patient with retroperitoneal hematoma. Tenn Med 2009; 102 (3): 37-39.
  10. Foerch C., Arai K., Van Cott E.M. et al. Rapid reversal of anticoagulation reduces hemorrhage volume in a mouse model of warfarin-associated intracerebral hemorrhage. J Cereb Blood Flow Metab 2009; 29 (5): 1015-1021.
  11. Angelo M., Stockner I., Wiedermann C.J. Bleeding risk and perioperative management of patients anticoagulated with vitamin K antagnosists. Wien Med Wschr 2008; 158 (21-22): 615-620.
  12. Crowther M.A., Warkentin T.E. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 2008; 111 (10): 4871-4879.
  13. McMillian W.D., Rogers F.B. Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review. J Trauma 2009; 66 (3): 942-950.
  14. Lapecorella M., Napolitano M., Bernardi F. et al. Effective hemostasis during minor surgery in a case of hereditary combined deficiency of vitamin k-dependent clotting factors. Clin Appl Thromb Hemost 2009; 13 (April 201016): 221-223.
  15. Aiyagari V., Testai F.D. Correction of coagulopathy in warfarin associated cerebral hemorrhage. Curr Opin Crit Care 2009; 5 (2): 87-92.
  16. Cosma Rochat M., Waeber G., Wasserfallen J.B. et al. Hospitalized women experiencing an episode of excessive oral anticoagulation had a higher bleeding risk than men. J Womens Hlth (Larchmt) 2009; 18 (3): 321-326.
  17. Kefer J.C., Turna B., Stein R.J. et al. Safety and efficacy of percutaneous nephrostolithotomy in patients on anticoagulant therapy. J Urol (Baltimore) 2009; 181 (1): 144-148.
  18. Williams T.M., Sadjadi J., Harken A.H. et al. The necessity to assess anticoagulation status in elderly injured patients. J Trauma 2008; 65 (4): 772-776.
  19. Ozpolat B., Yilmaz M.A., Yücel E. Lingual hematoma threatening airway obstruction in a patient on oral anticoagulation with warfarin. Blood Coagul Fibrinolys. 2007; 18 (6): 575-576.
  20. Wiedermann C.J., Stockner I. Warfarin-induced bleeding complications - clinical presentation and therapeutic options. Thromb Res 2008; 122: Suppl 2: 13-18.
  21. Barada K., Abdul-Baki H., El Hajj I.I. et al. Gastrointestinal Bleeding in the Setting of Anticoagulation and Antiplatelet Therapy. J Clin Gastroenterol 2008; 43: 5-12.
  22. Vigué B., Ract C., Tremey B. et al. Ultra-rapid management of oral anticoagulant therapy-related surgical intracranial hemorrhage. Intensive Care Med 2007; 33 (4): 721-725.
  23. Appelboam R., Thomas E.O. Warfarin and intracranial haemorrhage. Blood Rev 2009; 23 (1): 1-9.
  24. Marietta M., Pedrazzi P., Girardis M. et al. Intracerebral haemorrhage: an often neglected medical emergency. Intern Emerg Med 2007; 2 (1): 38-45.
  25. Neal M., Crowther M., Douketis J. et al. Reversal of vitamin K antagonist-ssociated coagulopathy: a survey of current practice. Thromb Res 2008; 122 (6): 864-866.
  26. Freeman W.D., Aguilar M.I. Management of warfarin-related intracerebral hemorrhage. Expert Rev Neurother 2008; 8 (2): 271-290.
  27. Aguilar M.I., Hart R.G., Kase C.S. et al. Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion. Mayo Clin Proc 2007; 82 (1): 82-92.
  28. Levy J.H., Tanaka K.A. Anticoagulation and reversal paradigms: is too much of a good thing bad? Anesth Analg 2009; 108 (3): 692-694.
  29. Kalainov D.M., Valentino L.A. Recombinant activated factor VII as a temporary reversal agent for warfarin anticoagulation: a cautionary report on an off-label application. Am J Orthop 2008; 37 (11): 572-574.
  30. Ozgonenel B., O'Malley B., Krishen P. et al. Warfarin reversal emerging as the major indication for fresh frozen plasma use at a tertiary care hospital. Am J Hematol 2007; 82 (12): 1091-1094.
  31. Laible B. Comparison of various phytonadione (vitamin K1) administration routes in achieving warfarin reversal. S D Med 2007; 60 (4): 158-159.
  32. Tharmarajah P., Pusey J., Keeling D. et al. Efficacy of warfarin reversal in orthopedic trauma surgery patients. J Orthop Trauma 2007; 21 (1): 26-30.
  33. Ilyas C., Beyer G.M., Dutton R.P. et al. Recombinant factor VIIa for warfarin-associated intracranial bleeding. J Clin Anesth 2008; 20 (4): 276-279.
  34. Frazee L.A., Bourguet C.C., Gutierrez W. et al. Retrospective evaluation of a method to predict fresh-frozen plasma dosage in anticoagulated patients. Am J Ther 2008; 15 (2): 111-118.
  35. Bruce D., Nokes T.J. Prothrombin complex concentrate (Beriplex P/N) in severe bleeding: experience in a large tertiary hospital. Crit Care 2008; 12 (4): R105.
  36. Lorenz R., Kienast J., Otto U. et al. Successful emergency reversal of phenprocoumon anticoagulation with prothrombin complex concentrate: a prospective clinical study. Blood Coagul Fibrinolys 2007; 18 (6): 565-570.
  37. Fuentes Pradera M.A., Suárez Delgado J.M., Yanes Vidal G. et al. Massive metrorrhagia in a patient under warfarin anticoagulation. Rapid reversal with a concentrated prothrombin complex (Prothromplex Immuno TIM 4 600 IU) Rev Esp Anestesiol Reanim 2006; 53 (1)0: 669-671.
  38. Siddiq F., Jalil A., McDaniel C. et al. Effectiveness of Factor IX complex concentrate in reversing warfarin associated coagulopathy for intracerebral hemorrhage. Neurocrit Care 2008; 8 (1): 36-41.
  39. Mallarkey G., Brighton T., Thomson A. et al. An evaluation of eptacog alfa in nonhaemophiliac conditions. Drugs 2008; 68 (12): 1665-1689.
  40. Ingerslev J., Vanek T., Culic S. Use of recombinant factor VIIa for emergency reversal of anticoagulation. J Postgrad Med 2007; 53 (1): 17-22.
  41. Leissinger C.A., Blatt P.M., Hoots W.K. et al. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol 2008; 83 (2): 137-143.
  42. Kalina M., Tinkoff G., Gbadebo A. et al. A protocol for the rapid normalization of INR in trauma patients with intracranial hemorrhage on prescribed warfarin therapy. Am Surg 2008; 74 (9): 858-861.
  43. Pabinger-Fasching I. Warfarin-reversal: results of a phase III study with pasteurised, nanofiltrated prothrombin complex concentrate. Thromb Res 2008; 122: Suppl 2: 19-22.
  44. Jennings H.R., Miller E.C., Williams T.S. et al. Reducing anticoagulant medication adverse vents and avoidable patient harm. Jt Comm J Qual Patient Saf 2008; 34 (4): 196-200.
  45. Dunning J., Versteegh M., Fabbri A. et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 2008; 34 (1): 73-92.
  46. Ratnaweera M., Janowski W., Simmons D. Multiple thrombotic events following warfarin reversal. Intern Med J 2007; 37 (8): 580-581.
  47. Levi M. Emergency reversal of antithrombotic treatment. Intern Emerg Med 2009; 4 (2): 137-145.
  48. Riess H.B., Meier-Hellmann A., Motsch J. et al. Prothrombin complex concentrate (Octaplex) in patients requiring immediate reversal of oral anticoagulation. Thromb Res 2007; 121 (1): 9-16.
  49. Thompson C.A. Stroke care specialist makes case for emergency warfarin-reversal protocol. Am J Health Syst Pharm 2007; 64 (7): 678, 680.
  50. Evans S.J., Biss T.T., Wells R.H. Emergency warfarin reversal with prothrombin complex concentrates: UK wide study. Br J Haematol 2008; 141 (2): 268-269.
  51. Evans S.J., Biss T.T., Wells R.H. Emergency warfarin reversal with prothrombin complex concentrates: UK wide study. Br J Haematol 2008; 141 (2): 268-269.
  52. Levy J.H., Tanaka K.A., Dietrich W. Perioperative hemostatic management of patients treated with vitamin K antagonists. Anesthesiology 2008; 109 (5): 918-926.
  53. Goldstein J.N., Rosand J., Schwamm L.H. Warfarin reversal in anticoagulant-associated intracerebral hemorrhage. Neurocrit Care 2008; 9 (2): 277-283.
  54. Tanaka K.A., Szlam F., Dickneite G. et al. Effects of prothrombin complex concentrate and recombinant activated factor VII on vitamin K antagonist induced anticoagulation. Thromb Res 2008; 122 (1): 117-123.
  55. Pabinger I., Brenner B., Kalina U. et al. Prothrombin complex concentrate (Beriplex P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial. J Thromb Haemost 2008; 6 (4): 622-631.
  56. Taketomi T., Szlam F., Levy J.H. et al. Warfarin reversal with prothrombin complex concentrate confers better antifibrinolytic activity compared with recombinant activated factor VII. Blood Coagul Fibrinolysis 2008; 19 (1): 106-108.
  57. Lemos Silva R., Carvalho de Sousa J., Calisto C. et al. Oral anticoagulant therapy. Fundamentals, clinical practice and recommendations. Rev Port Cardiol 2007; 26 (7-8): 769-788.

Copyright (c) 2012 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies