Reversal of Warfarin: Evidence for Fixed Dosing vs. Traditional Dosing of Prothrombin Complex Concentrate
by Angela C. Hayner, PharmD Candidate 2026, Sarah R. Peppard, PharmD, BCPS, BCCCP
Warfarin is a common oral anticoagulant used for the prevention and treatment of thromboembolic events. Although the use of warfarin has decreased due to the advent of direct oral anticoagulants (DOACs), there are certain indications and patient scenarios, such as antiphospholipid syndrome and severe renal or hepatic impairment, where warfarin use is preferred.2 Medicare Part D reported in 2019 that 1.74 million patients remain on warfarin. When compared to DOACs, warfarin has a higher risk of major bleeding: 6.57% and 11.04%, respectively. With warfarin, 0.5-5.2% of major bleeding events, defined by the International Society on Thrombosis and Haemostasis, that happen annually are associated with a mortality of 10%. In cases of intracranial hemorrhage (ICH), mortality can exceed 40%.
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2025 July/August Table of Contents
Warfarin is a common oral anticoagulant used for the prevention and treatment of thromboembolic events. Although the use of warfarin has decreased due to the advent of direct oral anticoagulants (DOACs), there are certain indications and patient scenarios, such as antiphospholipid syndrome and severe renal or hepatic impairment, where warfarin use is preferred.2 Medicare Part D reported in 2019 that 1.74 million patients remain on warfarin. When compared to DOACs, warfarin has a higher risk of major bleeding: 6.57% and 11.04%, respectively. With warfarin, 0.5-5.2% of major bleeding events, defined by the International Society on Thrombosis and Haemostasis, that happen annually are associated with a mortality of 10%. In cases of intracranial hemorrhage (ICH), mortality can exceed 40%.
Download PDF
2025 July/August Table of Contents