The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to m...

Anticoagulation therapy is used in several conditions to prevent or treat thromboembolism. Over the last 40 years, warfarin has been the oral anticoagulant of choice and has been considered the mainstay of treatment. However, its use is limited by a narrow therapeutic index and complex pharmacodynamics, necessitating regular monitoring and dose adjustments. Recently, two new oral anticoagulants...

The requirement of varying doses of warfarin for different individuals can be explained by environmental and genetic factors. We evaluated the frequency of vitamin K epoxide reductase complex subunit 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) variants together with patientdemographic characteristics and investigated their association with warfarin dose requirement with the ob...

Insufficiency fractures are a common cause of morbidity among geriatric patients worldwide. Improved outcomes are known to result from decreased delay to definitive operative fixation and mobilization. Use of warfarin is an important potential cause of delay. The ideal mode of warfarin reversal is currently unknown. Prothrombin complex concentrates (PCCs) offer rapid correction with small infus...

We would treat with 4-factor PCCs because otherwise—with an INR of 1.9—there is a high risk of further expansion of an already large ICH. Without reversal of the anticoagulant effects of warfarin, the patient’s life is at stake. At age 65 years, he has a reasonable chance to recover from a right-sided ICH if treated early and aggressively. In our eyes, early withdrawal of care is not an option!...

The use of novel oral anticoagulants (NOACs) for stroke and systemic embolism prevention in the setting of specifically non valvular atrial fibrillation has provided clinicians with a realistic treatment alternative to the traditional dose-adjusted, warfarin-based anticoagulation that is targeted to a therapeutic international normalized ratio range of 2.0-3.0. We discuss the use of dabigatran ...

Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or proper-anticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC) administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be...

Prothrombin complex concentrate (PCC), provides rapid reversal of warfarin anticoagulation [1] and has been shown to reduce mortality and haematoma expansion secondary to non-traumatic intracerebral haemorrhage, in warfarinised patients [2]. The measurement of international normalised ratio (INR) and administration of PCC to warfarinised patients with an INR >2 and suspected intracranial haemor...

A comparative study of prothrombin complex concentrates and fresh-frozen plasma for warfarin reversal under static and flow conditions. Thromb Haemost 2011; 106: 1215–23 22 Ogawa S, Szlam F, Dunn AL, et al. Evaluation of a novel flow chamber system to assess clot formation in factor VIII-deficient mouse and anti-factor IXa-treated human blood. Haemophilia 2012; 18: 926–32 23 Roest M, Reininger ...

conclusions race, age, body surface area, chronic kidney disease, cyp2c9*3 level, and vkorc1 variants could affect the dose of warfarin. to administer the proper doses of warfarin, patients and physicians might achieve the best results with the pharmacologist proficient anticoagulation database and recommended continuation program. owing to its’ unpredictability, caution must be taken when pres...