Reversal of warfarin-induced excessive anticoagulation with recombinant human factor VIIa concentrate
Reversal of warfarin-induced excessive anticoagulation with recombinant human factor VIIa concentrate
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DOI：
10.7326/0003-4819-137-11-200212030-00009
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发表时间：
2002-12-03
影响因子：
39.2
通讯作者：
Kessler, CM
中科院分区：
文献类型：
--
作者：
Deveras, RAE;Kessler, CM
背景：与华法林抗凝相关的出血与国际标准化比率(INR)高于治疗范围的持续时间和程度直接相关。目的：评价人重组因子VIIa(RFVIIa)在需要快速逆转华法林疗效的患者中的疗效和安全性。设计：非对照病例系列。地点：学术医学中心。患者：13例严重升高的INRS患者，需要立即逆转华法林诱导的抗凝。测量：在使用不同剂量的rFVIIa前后测量凝血酶原时间和INR。结果：无论rFVIIa剂量为15-90微克/公斤体重，所有患者都成功且迅速地治疗了严重延长的INR和出血并发症。使用rFVIIa的适应症包括高危人群的INR>10(n=5)、临床出血(n=4)和诊断或治疗(n=4)。结论：安全、快速和有效的rFVIIa应用纠正了严重延长的INRS；并可以避免或逆转与华法林抗凝相关的出血。
Background: Bleeding associated with warfarin anticoagulation correlates directly to duration and degree of international normalized ratio (INR) elevation above the therapeutic range. Safe and rapid reversal of excessive anticoagulation is occasionally needed to treat or avoid hemorrhagic complications.Objective: To evaluate the efficacy and safety of human recombinant factor VIIa (rFVIIa) concentrate in persons requiring rapid reversal of the effects of warfarin.Design: Uncontrolled case series.Setting: Academic medical center.Patients: 13 patients with critically increased INRs requiring immediate reversal of warfarin-induced anti coagulation.Measurements: Prothrombin time and INR were measured before and after administration of varying doses of rFVIIa.Results: Critically prolonged INR and bleeding complications were treated successively and rapidly in all patients, regardless of rFVIIa dose (range, 15 to 90 mug/kg of body weight). Indications for use of rFVIIa included an INR greater than 10 in high-risk persons (n = 5), clinical hemorrhage (n = 4), and diagnostic or therapeutic procedures (n = 4).Conclusion: Safe, rapid, and effective administration of rFVIIa corrects critically prolonged INRs; and can avert or reverse bleeding associated with warfarin anticoagulation.