Management of Patients with Gastrointestinal Hemorrhage While Receiving Warfarin: Vitamin K, Prothrombin Complex Concentrates and Others

IntroductionAnticoagulants, including vitamin K antagonists (VKA) are administered in a greeat majority of patients who are in need of prophylaxis and treatment of thromboembolic events allover the world.Many patients benefit from anticoagulant effects of VKA in acute and chronic venous and arterial thromboembolic diseases, although nowadays they have been partly replaced by newly generated direct oral anticoagulants.Treatment with VKA therapy necessitates great caution because of its narrow therapeutic window.These drugs also mandate frequent monitoring and dose adjustments.In brief, these agents are not free of adverse effects.The most important and deadly untoward effect is bleeding.The incidence of bleeding in anticoagulated patients is 15-20% in a year [1] and among these, around one-sixth are major bleeding complications (1.7-3.4%)[2].Although there have been many different treatment modalities in the management of these patients, PCC, FFP and vitamin K are the most commonly used treatment modalities, sometimes in combinations, to mitigate the effects of chronic or acute overdose of VKA.This article is a review and critical analysis of the most recent literature to analyse treatment with Prothrombin Complex Concentrate (PCC) in gastrointestinal hemorrhage (GIH) in patients on warfarin.