Departments of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Can J Anaesth. 2010 May;57(5):458-67. doi: 10.1007/s12630-009-9250-3. Epub 2010 Jan 15.
The purpose of this article is to review the effective options for the reversal of vitamin K antagonists (warfarin and it coumarin analogues) and to help identify the option best suited for the patient requiring urgent surgery.
Vitamin K antagonists, the mainstay in long-term anticoagulation therapy, can be reversed with the administration of vitamin K, frozen plasma (FP), recombinant factor VIIa (rFVIIa), or the recently approved four-factor prothrombin complex concentrate (PCC), Octaplex. While there is little evidence to suggest a superiority of PCC over FP, the availability of PCC in Canada is an important therapeutic addition requiring a thorough understanding of its pharmacology and risk benefit profile for the reversal of vitamin K antagonists. The use of PCC in the management of microvascular bleeding should be limited to very specific indications and should not be indicated in the routine management of massive blood loss.
In order to limit the blood loss associated with surgery and the management of uncontrolled bleeding, PCC is an important addition to our therapeutic armamentarium in the reversal of vitamin K antagonists.
本文旨在回顾维生素 K 拮抗剂（华法林及其香豆素类似物）逆转的有效方法，并帮助确定最适合需要紧急手术的患者的方法。
维生素 K 拮抗剂是长期抗凝治疗的主要药物，可以通过给予维生素 K、冷冻血浆（FP）、重组因子 VIIa（rFVIIa）或最近批准的四因子凝血酶原复合物浓缩物（PCC），即 Octaplex 来逆转。虽然几乎没有证据表明 PCC 优于 FP，但加拿大 PCC 的供应是一个重要的治疗补充，需要充分了解其药理学和逆转维生素 K 拮抗剂的风险效益比。PCC 用于微血管出血的管理应限于非常特定的适应证，不应作为大量失血常规管理的指征。
为了限制与手术相关的出血和失控性出血的管理，PCC 是我们在逆转维生素 K 拮抗剂方面治疗武器库中的一个重要补充。
