Choosing Wisely:

Don’t administer plasma or prothrombin complex concentrates for nonemergent reversal of vitamin K antagonists (i.e., outside of the setting of major bleeding, intracranial hemorrhage, or anticipated emergent surgery).

Rationale and Comments: Blood products can cause serious harm to patients, are costly, and are rarely indicated in the reversal of vitamin K antagonists. In nonemergent situations, elevations in the international normalized ratio are best addressed by holding the vitamin K antagonist and/or by administering vitamin K.
Sponsoring Organizations:
  • American Society of Hematology
  • Sources:
  • American College of Chest Physicians guidelines
  • Disciplines:
  • Hematologic
  • References: • Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ, Svensson PJ, Veenstra DL, Crowther M, Guyatt GH; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e152S-84S.
    • Scottish Intercollegiate Guidelines Network (SIGN). Antithrombotics: indications and management. Edinburgh (UK): 2012. 75 p. Report No. 129.

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