Ver el código de «Prothrombin complex concentrates»

==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
**Approved for treatment of hemophilia B (factor IX deficiency)
*4 factor PCC (Factors II, VII, IX, and X)
**Approved for reversal of vitamin K antagonists
*Does not require thawing or ABO-compatibility testing, and less risk for volume overload (in contrast to [[Fresh frozen plasma|FFP]]) <ref>Clinton J. Coil. “Transfusion Therapy.” Tintinalli’s Emergency Medicine: a Comprehensive Study Guide, by Judith E. Tintinalli et al., 8th ed., McGraw-Hill Education, 2016.</ref>

==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
*Fixed dose Kcentra equivalent to weight based (while being easier to administer and less expensive)<ref>Bitonti MT et al. Prospective Evaluation of a Fixed-Dose 4-Factor Prothrombin Complex Concentrate Protocol for Urgent Vitamin K Antagonist Reversal. J Emerg Med 2019;X(XX). https://doi.org/10.1016/j.jemermed.2019.10.013</ref><ref> Fixed-Dose PCC Dosing for Vitamin K Antagonist-Associated Hemorrhage: Is it Safe and Effective? by Kayvan Moussavi http://www.emdocs.net/fixed-dose-pcc-dosing-for-vitamin-k-antagonist-associated-hemorrhage-is-it-safe-and-effective/</ref>
**Baseline INR ≤7.5 and ≤100 kg: 1500 units of Kcentra
**Baseline INR >7.5 or >100 kg: 2000 units of Kcentra

==Pediatric Dosing==
*Safety and efficacy not established

==Special Populations==
*[[Drug Ratings in Pregnancy|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%).<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>

===Common===
*Thromboembolic events
*[[Headache]] 
*[[Hypotension]] (4.9%)
*[[Nausea/vomiting]]
*Arthralgia
*[[ICH]] (2.9%)
*Mental status change
*Hypertension (2.9%)

==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==
*[[Anticoagulant reversal for life-threatening bleeds]]
*[[Anti-platelet agent reversal]]
*[[Blood products]]
*[[Warfarin reversal]]

==References==
<references/>

[[Category:Pharmacology]]
[[Category:Heme/Onc]]