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.