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{
    "pk": 18120,
    "title": "Reversal of Warfarin-Induced Hemorrhage in the Emergency Department",
    "subtitle": null,
    "abstract": "Warfarin, an oral vitamin K antagonist, is used to prevent arterial and venous thromboembolism in patients suffering from a multitude of diseases. In 2004, 31 million warfarin prescriptions were dispensed in the United States. Warfarin inhibits the activation of the vitamin K–dependent clotting factors (Factors II, VII, IX, and X) and regulatory proteins (proteins C, S, and Z). It is one of the leading drugs implicated in emergency room visits for adverse drug reactions. Annually the frequency of bleeding complications associated with overanticoagulation is 15% to 20%, with fatal bleeds measuring as high as 1% to 3%. The most effective method of warfarin reversal involves the use of Four Factor Prothrombin Complex Concentrate (PCC), which is widely used throughout Europe but is unavailable in the United States. The current therapies available to emergency room physicians in the United States are fresh frozen plasma, recombinant Factor VIIa (rFVIIa), Factor Eight Inhibitory Bypassing Activity, or Three Factor PCC concomitantly administered with vitamin K. We review the advantages and disadvantages of these therapies and recommend Three Factor PCC with small doses of rFVIIa and with vitamin K in life-threatening situations if Four Factor PCC is unavailable. [West J Emerg Med. 2011;12(4):386–392.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by-nc/4.0"
    },
    "keywords": [
        {
            "word": "warfarin reversal"
        },
        {
            "word": "Fresh frozen plasma"
        },
        {
            "word": "prothrombin complex concentrate"
        },
        {
            "word": "recombinant factor VIIa"
        },
        {
            "word": "Pharmacology and Toxicology"
        }
    ],
    "section": "Clinical Practice",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/12f3z5c9",
    "frozenauthors": [
        {
            "first_name": "Meena",
            "middle_name": "",
            "last_name": "Zareh",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Andrew",
            "middle_name": "J",
            "last_name": "Davis",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Sean",
            "middle_name": "O",
            "last_name": "Henderson",
            "name_suffix": "",
            "institution": "Department of Emergency Medicine, Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California",
            "department": "None"
        }
    ],
    "date_submitted": "2010-07-29T07:00:00Z",
    "date_accepted": "2010-07-29T07:00:00Z",
    "date_published": "2011-05-27T07:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/18120/galley/9238/download/"
        }
    ]
}