Warfarin (Coumadin) Reversal

This Global website is not intended to represent or suggest that particular products are approved or authorized in any particular jurisdiction. You should not construe anything on this website as a promotion or solicitation for any product or service, or as suggesting that a product or service be used where it is not approved or authorized by applicable law and regulation in a particular country, territory, or jurisdiction. To learn which products are approved or authorized in particular countries, please consult the appropriate country-specific website.
This content is intended for use by healthcare professionals.

Rapid Warfarin Reversal

In serious bleeding due to excessive warfarin therapy (over-anticoagulation), rapid warfarin (Coumadin) reversal is required. A number of options for warfarin (Coumadin) reversal are available, including:

  • Withdrawal of oral anticoagulants
  • Vitamin K
  • Fresh frozen plasma
  • Prothrombin complex concentrates
Several healthcare guidelines suggest or recommend PCCs, such as the four-factor PCC manufactured by CSL Behring under the trade names Beriplex® P/N , Confidex® and Kcentra®, as the treatment of choice when normal plasma levels of vitamin K must be urgently restored in a bleeding emergency. 7-8 In countries where PCC products have the appropriate indication, guidelines similarly recommend use of PCCs before emergency surgery in patients undergoing oral anticoagulation therapy (ie, warfarin, often known as Coumadin). Warfarin reversal is achieved rapidly and completely with PCCs. 7-8  Furthermore, warfarin (Coumadin) reversal is achieved rapidly and completely with prothrombin complex concentrates. 7-8

Table 1. Options for warfarin (Coumadin) reversal 8 
Type of reversal
Rapid (complete; within 10–15 minutes)
Prothrombin complex concentrate (immediate replacement of vitamin K-dependent coagulation factors) plus intravenous vitamin K (to switch on endogenous synthesis of vitamin K-dependent coagulation factors within a few hours)
Fast (partial)
Fresh frozen plasma (immediate replacement of vitamin K-dependent coagulation factors – but the correction of coagulopathy is partial)
Prompt (within 4–6 hours)
Intravenous vitamin K
Slow (within 24 hours)
Oral vitamin K
Very slow (3–5 days)
Omit oral anticoagulation therapy (no vitamin K)

Table 2. Acquired vitamin K coagulation factor deficiencies 2 9  
Deficiency of vitamin K-dependent factors (II [prothrombin], VII, IX and X)
Vitamin K antagonist therapy (e.g. oral anticoagulation using warfarin)
Oral anticoagulants are used to treat thromboembolic disorders and act by inhibiting vitamin K to prevent the production of coagulation factors, thereby preventing blood clotting. Their overuse can also cause acquired bleeding.
Vitamin K deficiency
Caused by inadequate diet or malabsorption of vitamin K, which leads to decreased activation of the vitamin K-dependent coagulation factors
Hemorrhagic disease of the newborn
Coagulation abnormalities in newborns due to vitamin K deficiency. The most common sites of bleeding are the umbilicus mucous membranes, gastrointestinal tract and venipunctures.
Biliary obstruction
Results in impaired absorption of vitamin K.

Beriplex® P/N (known in some areas as Confidex®) is a prothrombin complex concentrate (PCC) from CSL Behring indicated for:
  • Treatment and perioperative prophylaxis of bleedings in acquired deficiency of the prothrombin complex coagulation factors, such as deficiency caused by treatment with vitamin K antagonists, or in case of overdose of vitamin K antagonists, when rapid correction of the deficiency is needed.
  • Treatment and perioperative prophylaxis of bleedings in congenital deficiency of any of the vitamin K dependent coagulation factors when purified specific coagulation factor products are not available.
In the U.S., the product has been approved under the name Kcentra® (Prothrombin Complex Concentrate [Human]). Kcentra is indicated for the urgent reversal of vitamin K antagonist (VKA, e.g., warfarin) therapy in adult patients with acute major bleeding or needing an urgent surgery or other invasive procedure.

Package Inserts

Product Websites

Not all products are available in every country. To learn what products are available in your country, visit your CSL Behring country site.

LinkedIn Twitter Facebook Google+