Difference between revisions of "Prothrombin complex concentrates"

(Pharmacology)
(References)
 
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*Dosage Forms:lypophilized concentrate for reconstitution 500u/vial and 1000u/vial
 
*Dosage Forms:lypophilized concentrate for reconstitution 500u/vial and 1000u/vial
 
*Common Trade Names: Kcentra
 
*Common Trade Names: Kcentra
 +
*3 factor PCC (Factors II, IX, and X), would need to supplement with factor VII for reversal if using 3 factor PCC
 +
*4 factor PCC (Factors II, VII, IX, and X)
  
 
==Adult Dosing==
 
==Adult Dosing==
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**INR 4-6: 35units/kg, not to exceed 3500 units
 
**INR 4-6: 35units/kg, not to exceed 3500 units
 
**INR >6: 50units/kg, not to exceed 5000 units
 
**INR >6: 50units/kg, not to exceed 5000 units
 +
*Consider rechecking INR after 15 minutes to determine need for redosing
  
 
==Pediatric Dosing==
 
==Pediatric Dosing==
Safety and efficacy not established
+
*Safety and efficacy not established
  
 
==Special Populations==
 
==Special Populations==
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===Serious===
 
===Serious===
*thromboembolism
+
*Patients receiving PCC for reversal of a vitamin K antagonist ([[Warfarin]]) due to life-threatening bleeding have a rate of thromboembolism which is similar to the rate in patients who receive [[Fresh frozen plasma]] (7.3% v 7.1%).<ref>Milling, TJ Jr et al. Thromboembolic events after vitamin K antagonist reversal with 4-factor prothrombin complex concentrate: exploratory analyses of two randomized, plasma-controlled studies. Ann Emerg Med. 2016 Jan;67(1):96-105.  PMID: 26094105</ref>
*blood product (hepatitis, HIV)
+
 
 
===Common===
 
===Common===
*thromboembolic events (8.7%)
+
*Thromboembolic events
*[[headache]] (7.8%)
+
*[[Headache]]  
*[[hypotension]] (4.9%)
+
*[[Hypotension]] (4.9%)
*[[nausea/vomiting]]
+
*[[Nausea/vomiting]]
*arthralgia
+
*Arthralgia
 
*[[ICH]] (2.9%)
 
*[[ICH]] (2.9%)
*mental status change (2.9%)
+
*Mental status change
*hypertension (2.9%)
+
*Hypertension (2.9%)
  
 
==Pharmacology==
 
==Pharmacology==
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==See Also==
 
==See Also==
*[[Blood transfusions]]
+
*[[Anticoagulant reversal for life-threatening bleeds]]
*[[Dabigatran (Pradaxa) Reversal]]
+
*[[Anti-platelet agent reversal]]
 +
*[[Blood products]]
 +
*[[Warfarin reversal]]
  
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 
[[Category:Pharmacology]]
 
[[Category:Pharmacology]]
 +
[[Category:Heme/Onc]]

Latest revision as of 22:09, 23 September 2019

General

  • Type: Hemostatics, blood components
  • Dosage Forms:lypophilized concentrate for reconstitution 500u/vial and 1000u/vial
  • Common Trade Names: Kcentra
  • 3 factor PCC (Factors II, IX, and X), would need to supplement with factor VII for reversal if using 3 factor PCC
  • 4 factor PCC (Factors II, VII, IX, and X)

Adult Dosing

  • Based on pretreatment INR, units based on factor 9 content
    • INR 2-4: 25units/kg, not to exceed 2500 units
    • INR 4-6: 35units/kg, not to exceed 3500 units
    • INR >6: 50units/kg, not to exceed 5000 units
  • Consider rechecking INR after 15 minutes to determine need for redosing

Pediatric Dosing

  • Safety and efficacy not established

Special Populations

  • Pregnancy Rating: C
  • Lactation: Unknown, breast feeding not advised
  • Renal Dosing
    • Adult-N/A
    • Pediatric-N/A
  • Hepatic Dosing
    • Adult-N/A
    • Pediatric-N/A

Contraindications

  • Allergy to class/drug
  • DIC
  • known HIT (Heparin induced thrombocytopenia)

Serious

  • Patients receiving PCC for reversal of a vitamin K antagonist (Warfarin) due to life-threatening bleeding have a rate of thromboembolism which is similar to the rate in patients who receive Fresh frozen plasma (7.3% v 7.1%).[1]

Common

Pharmacology

  • Half-life: 4-60 hours, depending on clotting factor
  • Metabolism:
  • Excretion:
  • Mechanism of Action: 4 factor PCC contains factors II, VII, XI, X, protein C and S

See Also

References

  1. Milling, TJ Jr et al. Thromboembolic events after vitamin K antagonist reversal with 4-factor prothrombin complex concentrate: exploratory analyses of two randomized, plasma-controlled studies. Ann Emerg Med. 2016 Jan;67(1):96-105. PMID: 26094105