Key result
Corrective treatment with fresh frozen plasma and 3F-PCC failed to reverse coagulopathy in a ruptured AAA patient on warfarin, requiring co-administration of vitamin K to reduce INR to <1.5.
Why the study?
Warfarin use in patients presenting with ruptured abdominal aortic aneurysm can complicate surgical preparation and affect prognosis.
Case Report (n=1)
No
In patients with abdominal aortic aneurysm and warfarin-induced coagulopathy, corrective treatment with FFP or 3F-PCC alone may fail, requiring aggressive reversal with co-administration of vitamin K.
Rebound INR despite aggressive reversal warrants caution in warfarin-treated AAA; leaves open optimal reversal strategies for study.
Abdominal aortic aneurysm (AAA) is not uncommon to cause coagulopathy. Warfarin use in patients presented with ruptured AAA can further complicate the preparation for surgical intervention and affect prognosis. We reported a case of impending rupture AAA that progressed to contained leak AAA in a warfarin user, with persistent elevated and rebound international normalized ratio (INR) despite aggressive correction with fresh frozen plasma (FFP) and three-factor prothrombin complex concentrate (3F-PCC). Persistent and rebound coagulopathy is possible in AAA. Corrective treatment with FFP or 3F-PCC alone does not always guarantee the successful reversal of coagulopathy in AAA. Some cases, especially those that failed the initial corrective treatment, require more aggressive reversal with co-administration of vitamin K. This case described coagulopathy in AAA, anticoagulation reversal agents used and emphasized the importance of rigorous coagulation profile monitoring in managing AAA.
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Koh et al. (2022) conducted a case report in Abdominal aortic aneurysm with coagulopathy (n=1). Fresh frozen plasma, 3F-PCC, and Vitamin K was evaluated on Reversal of coagulopathy (INR reduction). Corrective treatment with fresh frozen plasma and 3F-PCC failed to reverse coagulopathy in a ruptured AAA patient on warfarin, requiring co-administration of vitamin K to reduce INR to <1.5.
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