Epidemiological features of warfarin overdose and efficacy of prothrombin complex concentrates

The aims of this study were to investigate the epidemiological features of warfarin overdose and evaluate the efficacy of prothrombin complex concentrate (PCC) for overdose treatment. The hospital records of 106 patients admitted to the emergency department (ED) for warfarin overdose during a two-year period were evaluated retrospectively. Demographic and epidemiological data as well as treatments were recorded. The data from 15 patients administered PCC were compared with those of other patients. The patient population consisted of 53 (50%) males and 53 (50%) females with a mean age of 70.2±14.5 years. Forty-five (42.4%) patients were admitted to the ED with bleeding disorders; 61 (57.6%) patients were admitted for other symptoms such as headache, syncope, trauma related injuries. Atrial fibrillation (n=50, 47.1%) was the most common indication for treatment with a vitamin K antagonist (VKA). Other common indications were transient ischemic attack, stroke (n=43, 40.5%) and valvular heart disease (n=17, 16%). Vitamin K was the preferred treatment for VKA reversal in 32 (30.2%) patients. Fresh-frozen plasma (FFP) was preferred in 23 (21.7%) patients. Fifteen (14.1%) patients required acute reversal of VKA with PCC. The anticoagulant drug was discontinued in 58 (54.7%) patients. Erythrocyte suspension (ES) and thrombocyte suspension (TS)transfusion rates were higher in the PCC-administered group; hospitalization rates were also higher in this group. ED length of stay (LOS) was shorter in this group. Initial international normalized ratio (INR) levels were significantly higher in the PCC group (5.68±3.74 versus 13.17±5.15). As the elderly population increases, warfarin and VKArelated complications will be a more significant portion of ED practice.ED physicians should be experienced in acute reversal of VKA with PCC, and be familiar with the possible complications of FFP and PCC.J. Exp. Clin. Med., 2013; 30:327-330