Correction of coagulopathy secondary to oral and parenteral anticoagulants

Warfarin and heparin are the most commonly used anticoagulants in the United States. Intracranial hemorrhage is the most serious complication of oral or parenteral anticoagulation, and urgent reversal of anticoagulation is indicated in this situation. Traditional methods of reversal of the anticoagulant effect of warfarin involving the use of vitamin K and fresh frozen plasma are slow and relatively ineffective in rapidly reversing coagulopathy. The use of agents such as prothrombin complex conjugates and recombinant activated factor VII may lead to more rapid reversal, although improved clinical outcome is yet to be proven. Unfractionated heparin can be reversed by the use of protamine sulfate. Newer anticoagulants, including low-molecular-weight heparin, fondaparinux, and direct thrombin inhibitors, have no specific antidotes.