Latest updates for warfarin reversal, cryoprecipitate and more
Health professionals can now access the latest updates for warfarin reversal (to support use of Beriplex®) and updates related to the transition to split apheresis cryoprecipitate and cryodepleted plasma components on the Lifeblood site.
This page now reflects the updated recommendations produced by THANZ for warfarin reversal in the setting of four-factor prothrombin complex concentrate.
All dosing decisions should consider the individual patient, including:
• their degree of bleeding
• the ability to perform timely and adequate haemostatic interventions, and
• their underlying thrombotic risk that warranted anticoagulation with warfarin in the first place.
The updated 2024 THANZ recommendations for warfarin reversal in the setting of four-factor prothrombin complex concentrate advised that the management of non-bleeding patients on warfarin remain unchanged (from the 2013 update of consensus guidelines for warfarin reversal).
Transition to split apheresis cryoprecipitate and cryodepleted plasma components
In addition to Lifeblood’s communications regarding the transition, the pages on Cryoprecipitate and Cryodepleted plasma have also been updated to include the typical unit content for ease of reference and to support the review of your organisation's policies and guidelines.
The Cryoprecipitate page also includes information on dosing.
Adult cryoprecipitate dosing
In Australia, the National Blood Authority’s (NBA) Patient blood management guideline for adults with critical bleeding recommend an adult dose of fibrinogen of 3-4 g of fibrinogen, which may be achieved by using:
• 10 units of whole blood cryoprecipitate, or
• 10 units of split apheresis cryoprecipitate, or
• a combination of these as both unit types are equivalent and interchangeable.
This dose of 3-4 g of fibrinogen can also be achieved by using 4 units of large dose apheresis cryoprecipitate units while stock is still available.
Paediatric cryoprecipitate dosing
The patient blood management guidelines: Module 6 Neonatal and Paediatrics provide dosing guidance within the critical bleeding protocol template for infants and children. The locally adapted health service critical bleeding protocol and other relevant transfusion guidelines (specific to the particular patient group) should be referred to, and expert advice should be sought.
Important
When reviewing international studies of fibrinogen replacement, ensure that the current fibrinogen content in Australian cryoprecipitate is considered when estimating equivalence. Due to differences in manufacturing process between Blood Services internationally, fibrinogen content per 'unit' (pack) and per mL can vary considerably.
