Alfonso Iorio, HIRU CRL-140, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada, Tel.: +1 905 525 9140 ext 22421, E-mail:
Thromb Haemost. 2016 Oct 28;116(5):879-890. doi: 10.1160/TH16-04-0266. Epub 2016 Aug 4.
Urgent reversal of warfarin is required for patients who experience major bleeding or require urgent surgery. Treatment options include the combination of vitamin K and coagulation factor replacement with either prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). However, the optimal reversal strategy is unclear based on clinically relevant outcomes. We searched in MEDLINE, EMBASE and Cochrane library to December 2015. Thirteen studies (5 randomised studies and 8 observational studies) were included. PCC use was associated with a significant reduction in all-cause mortality compared to FFP (OR= 0.56, 95 % CI; 0.37-0.84, p=0.006). A higher proportion of patients receiving PCC achieved haemostasis compared to those receiving FFP, but this was not statistically significant (OR 2.00, 95 % CI; 0.85-4.68). PCC use was more likely to achieve normalisation of international normalised ratio (INR) (OR 10.80, 95 % CI; 6.12-19.07) and resulted in a shorter time to INR correction (mean difference -6.50 hours, 95 %CI; -9.75 to -3.24). Red blood cell transfusion was not statistically different between the two groups (OR 0.88, 95 % CI: 0.53-1.43). Patients receiving PCC had a lower risk of post-transfusion volume overload compared to FFP (OR 0.27, 95 % CI; 0.13-0.58). There was no statistically significant difference in the risk of thromboembolism following administration of PCC or FFP (OR 0.91, 95 % CI; 0.44-1.89). In conclusion, as compared to FFP, the use of PCC for warfarin reversal was associated with a significant reduction in all-cause mortality, more rapid INR reduction, and less volume overload without an increased risk of thromboembolic events.
对于发生大出血或需要紧急手术的患者，需要紧急逆转华法林。治疗选择包括维生素 K 和凝血因子替代物的联合应用，包括凝血酶原复合物浓缩物（PCC）或新鲜冷冻血浆（FFP）。然而，基于临床相关结果，最佳的逆转策略尚不清楚。我们在 MEDLINE、EMBASE 和 Cochrane 图书馆中进行了检索，检索时间截至 2015 年 12 月。共纳入 13 项研究（5 项随机研究和 8 项观察性研究）。与 FFP 相比，PCC 的使用与全因死亡率显著降低相关（OR=0.56，95%CI；0.37-0.84，p=0.006）。与接受 FFP 的患者相比，接受 PCC 的患者更有可能达到止血，但这没有统计学意义（OR 2.00，95%CI；0.85-4.68）。PCC 的使用更有可能使国际标准化比值（INR）正常化（OR 10.80，95%CI；6.12-19.07），并使 INR 校正时间缩短（平均差值-6.50 小时，95%CI；-9.75 至-3.24）。两组之间的红细胞输血没有统计学差异（OR 0.88，95%CI：0.53-1.43）。与 FFP 相比，接受 PCC 的患者发生输血后血容量超负荷的风险较低（OR 0.27，95%CI；0.13-0.58）。PCC 或 FFP 给药后血栓栓塞事件的风险没有统计学差异（OR 0.91，95%CI；0.44-1.89）。总之，与 FFP 相比，PCC 用于华法林逆转与全因死亡率显著降低、INR 更快降低以及血容量超负荷减少相关，而血栓栓塞事件的风险没有增加。
