Prothrombin-Complex Concentrates (PCC )

This morning we discussed the use of PCCs in reversing the INR. PCC is the combinations of vitamin K-dependent coagulation factors (ie, factors II, VII, IX, and X). It is used to normalize the INR and acts more rapidly than FFP or vitamin K alone.

PCC available in Canada is Octaplex (there are more in the market). This is a human blood product derivative (not a recombinant).

Advantage of using PCC is the much lower volume load compared to FFP. Thrombotic complications (such as DIC or MI) have been reported with PCC, but this risk is difficult to quantify.

Vitamin K should be given if you need to completely reveres INR even when using PCC to avoid delayed secondary rise in the INR as the coagulation factors are metabolized (remember factor VII has a half-life of four to six hours in vivo).

The cost of INR reversal with PCC is between $1000-$3000 USD.

Here is a review on reversal of vitamin K agonist therapy.