Prothrombin complex concentrate reverses the effects of
warfarin and other
vitamin K antagonist anti-coagulants and is used in cases of significant bleeding in people with a
coagulopathy. It is also used when such a person must undergo an emergency operation.[17] Other uses include a deficiency of one of the included clotting factors, either congenital or due to
liver disease, and
hemophilia.[17] Several guidelines, including those from the
American College of Chest Physicians, recommend prothrombin complex concentrate for warfarin reversal in people with serious bleeding.[18][19][20][21]
For rapid anticoagulation reversal for surgery, four-factor prothrombin complex concentrate reduces
international normalized ratio (INR) and decreases bleeding during surgery when compared with administration of fresh frozen plasma. No differences in thromboembolic event was found.[22]
Contraindications
The package insert states that prothrombin complex concentrate is contraindicated in patients with
disseminated intravascular coagulation, a pathological activation of coagulation,[23] because giving clotting factors would only further fuel this process. However, if the PCC is given because factor levels are low, it can restore normal coagulation. As PCC products contain
heparin, they are contraindicated in patients with
heparin-induced thrombocytopenia.[23]
Chemistry
Prothrombin complex concentrate contains a number of blood clotting factors. Typically this includes
factor II,
IX, and
X.[9] Some versions also contain
factor VII,
protein C, and
protein S.[10][23]Heparin may be added to stop early activation of the factors.[10]
In the United States a dose of prothrombin complex concentrate costs about US$900.[26] The Australian National Blood Authority sets Prothrombinex (500 IU) at around AUD$327. [27]
Brand names
A number of different formulations are available globally.[28]
^
abcWilson MD, Davis JE (2014).
"Antithrombotic Reversal Agents". In Perkins JC (ed.). Hematology/Oncology Emergencies, An Issue of Emergency Medicine Clinics of North America. Elsevier Health Sciences. p. 720.
ISBN9780323320290.
Archived from the original on 5 January 2017.
^
abcBritish national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 171.
ISBN9780857111562.
^World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization.
hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^World Health Organization (2015). The selection and use of essential medicines. Twentieth report of the WHO Expert Committee 2015 (including 19th WHO Model List of Essential Medicines and 5th WHO Model List of Essential Medicines for Children). Geneva: World Health Organization. p. 510.
hdl:10665/189763.
ISBN9789241209946.
ISSN0512-3054. WHO technical report series;994.
^"Factor IX (Recombinant)". The American Society of Health-System Pharmacists.
Archived from the original on 24 September 2017. Retrieved 8 December 2016.
^Haemostasis and Thrombosis Task Force for the British Committee for Standards in Haematology. Guidelines on oral anticoagulation: 3rd edition. Br J Haematol. 1998;101:374-387.
^Baker RI, Coughlin PB, Gallus AS, Harper PL, Salem HH, Wood EM (November 2004). "Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis". The Medical Journal of Australia. 181 (9): 492–7.
doi:
10.5694/j.1326-5377.2004.tb06407.x.
PMID15516194.
S2CID3035209.
^Palareti G (1998). "A guide to oral anticoagulant therapy. Italian Federation of Anticoagulation Clinics". Haemostasis. 28 (Suppl 1): 1–46.
doi:
10.1159/000054103.
PMID9820837.
S2CID202659825.
^Harrison BA (2014).
"Pulmonary Arterial Hypertension". In Murray MJ, Rose SH, Wedel DJ, Wass CT, Harrison BA, Mueller JT (eds.). Faust's Anesthesiology Review: Expert Consult (4th ed.). Elsevier Health Sciences. p. 543.
ISBN9781437703672.
Archived from the original on 9 January 2017.
^Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL (2014).
Miller's Anesthesia (8 ed.). Elsevier Health Sciences. p. 1892.
ISBN9780323280112.
Archived from the original on 9 January 2017.