Abstract
Oral anticoagulant therapy (OAT) is associated with the following two complications: hemorrhagic complications caused by excessive coagulation and thrombotic complications caused by ineffective coagulation. Intracranial hemorrhage (ICH) is a severe complication of OAT, and the resulting mortality rate is >50%. Therefore, early and complete reversal of OAT is necessary to improve patient prognosis.
Although the first choice for OAT reversal is fresh-frozen plasma (FFP), the proportions of vitamin K-dependent coagulation factors vary in each unit of FFP; therefore, the efficacy of this treatment is unpredictable. Furthermore, the duration for FFP-mediated OAT reversal is long, and a rapid infusion of sufficient volume of FFP may be associated with an increased risk of transfusion-associated circulatory overload. Prothrombin complex concentrates (PCCs) are effective for emergent cases. However, their use in Japan is an off-label indication in patients with OAT-associated ICH.
Prevention of thrombosis is essential during the reversal of OAT. After complete OAT reversal in patients with prosthetic heart valves who experience ICH, it is advisable to begin treatment with heparin and to reintroduce OAT 1–2 weeks later.
The cause of prosthetic heart valve obstruction as either a thrombus or a pannus should be differentiated to determine whether thrombolytic therapy should be introduced or not. Furthermore, in patients with a history of ICH who experience a thrombosed prosthetic valve, thrombolytic therapy is inadvisable.
