Warfarin reversal: consensus guidelines on behalf of the Australasian Society of Thrombosis and Haemostasis

Anticoagulation is very effective for primary and secondary prevention of thromboembolic events. However, questions persist about the risks and management of over-anticoagulation. Major bleeding, which includes intracranial haemorrhage and bleeding leading to death or hospitalisation, has been reported in 1.2%-8.1% of patients during each year of long-term warfarin therapy 1,2 Despite these bleeding risks, warfarin use in Australia has increased between 6% and 9% per annum in the last 4 years, with current growth at about 9% per year. 3 It is commonly used in the community setting for indications such as uncomplicated deep vein thrombosis and stroke prophylaxis in atrial fibrillation. By understanding the pharmacokinetics and pharmacodynamics of warfarin, and therefore the potential modifiers of warfarin's effects, these bleeding risks can be minimised through preventive strategies with or without warfarin reversal. These consensus guidelines offer advice. on. these preventive strategies and the principles of warfarin reversal, as well as bridging therapy in the face of different clinical settings. The recommendations draw on available evidence and the clinical experience of the panel of author practitioners.