Prothrombin Complex Concentrate: Anticoagulation Reversal and Beyond
Prothrombin complex concentrates (PCCs) are plasma‐derived coagulation factor concentrates. All PCCs contain factors II, IX and X, and four‐factor PCCs also contain factor VII. Most PCCs contain coagulation factors that are not activated, but activated PCC contains activated factor VII (FVII). The ratio of quantities of coagulation factor concentrations varies from one PCC to another . Further differences between PCCs relate to constituents other than coagulation factors: they contain different amounts of inhibitors, such as heparin, antithrombin and proteins C, S and Z. Despite this variability, however, levels of inhibitors are always much lower than those of the coagulation factors.
PCCs are mainly used for emergency reversal of the effects of vitamin K antagonists (VKAs). Circumstances demanding rapid anticoagulation reversal include unplanned, urgent surgery and trauma‐related bleeding. VKAs, such as warfarin, function by preventing synthesis of the...
- 4.Goldstein JN, Refaai MA, Milling TJ Jr et al (2015) Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 385:2077–2087CrossRefGoogle Scholar
- 6.Tazarourte K, Riou B, Tremey B, Samama CM, Vicaut E, Vigue B (2014) Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study). Crit Care 18:R81CrossRefGoogle Scholar
- 26.Görlinger K, Dirkmann D, Hanke AA et al (2011) First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 115:1179–1191PubMedGoogle Scholar